Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post-implementation expenditures.
Relph, S.
Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post-implementation expenditures. - 2013
NMUH Staff Publications Epub ahead of print
<div style="line-height: 17.999801635742188px;"><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;"><span class="highlight">Enhanced</span> <span class="highlight">Recovery</span> <span class="highlight">After</span> <span class="highlight">Surgery</span> programmes were first conceived to optimise perioperative patient care and have been delivered by surgical specialities in the UK for over a decade. Although their safety and acceptability have been ratified in many surgical fields including gynaecology and colorectal <span class="highlight">surgery</span>, the <span class="highlight">cost</span> <span class="highlight">effectiveness</span> of its implementation in benign <span class="highlight">vaginal</span> <span class="highlight">surgery</span> remains unclear. In this case-control study, the perioperative expenditure for 45 women undergoing <span class="highlight">vaginal</span> <span class="highlight">hysterectomy</span> at a North London teaching hospital <span class="highlight">after</span> implementation of an <span class="highlight">enhanced</span> <span class="highlight">recovery</span>pathway was compared with 45 matched controls prior to implementation. Frequency of catheter use (84.4% vs. 95.6%) and median length of stay (23.5 vs. 42.9 h) were significantly lower following implementation of pathway (both p < 0.05). Although <span class="highlight">enhanced</span> <span class="highlight">recovery</span> patients were more likely to attend the accident and emergency department for minor symptoms following discharge (15.6% vs. 0%, p < 0.05), the inpatient readmission rate (6.7% vs. 0.0%, p > 0.05) was similar in both groups. Establishing the <span class="highlight">programme</span> incurred additional <span class="highlight">expenditures</span> including delivering a patient-orientated gynaecology 'school' and employing a specialist <span class="highlight">enhanced</span> <span class="highlight">recovery</span> nurse, but despite these, we demonstrated a saving of 15.2% (or 164.86) per patient. The <span class="highlight">cost</span> efficiency savings, coupled with increased satisfaction and no rise in morbidity, offers a very attractive means of managing women undergoing <span class="highlight">vaginal</span> <span class="highlight">hysterectomy</span>. We believe that our data can be reproduced in other centres and recommend that the pathway be used routinely in women undergoing these procedures. </span></p></div>
07496753
Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post-implementation expenditures. - 2013
NMUH Staff Publications Epub ahead of print
<div style="line-height: 17.999801635742188px;"><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;"><span class="highlight">Enhanced</span> <span class="highlight">Recovery</span> <span class="highlight">After</span> <span class="highlight">Surgery</span> programmes were first conceived to optimise perioperative patient care and have been delivered by surgical specialities in the UK for over a decade. Although their safety and acceptability have been ratified in many surgical fields including gynaecology and colorectal <span class="highlight">surgery</span>, the <span class="highlight">cost</span> <span class="highlight">effectiveness</span> of its implementation in benign <span class="highlight">vaginal</span> <span class="highlight">surgery</span> remains unclear. In this case-control study, the perioperative expenditure for 45 women undergoing <span class="highlight">vaginal</span> <span class="highlight">hysterectomy</span> at a North London teaching hospital <span class="highlight">after</span> implementation of an <span class="highlight">enhanced</span> <span class="highlight">recovery</span>pathway was compared with 45 matched controls prior to implementation. Frequency of catheter use (84.4% vs. 95.6%) and median length of stay (23.5 vs. 42.9 h) were significantly lower following implementation of pathway (both p < 0.05). Although <span class="highlight">enhanced</span> <span class="highlight">recovery</span> patients were more likely to attend the accident and emergency department for minor symptoms following discharge (15.6% vs. 0%, p < 0.05), the inpatient readmission rate (6.7% vs. 0.0%, p > 0.05) was similar in both groups. Establishing the <span class="highlight">programme</span> incurred additional <span class="highlight">expenditures</span> including delivering a patient-orientated gynaecology 'school' and employing a specialist <span class="highlight">enhanced</span> <span class="highlight">recovery</span> nurse, but despite these, we demonstrated a saving of 15.2% (or 164.86) per patient. The <span class="highlight">cost</span> efficiency savings, coupled with increased satisfaction and no rise in morbidity, offers a very attractive means of managing women undergoing <span class="highlight">vaginal</span> <span class="highlight">hysterectomy</span>. We believe that our data can be reproduced in other centres and recommend that the pathway be used routinely in women undergoing these procedures. </span></p></div>
07496753
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