Clinical and financial impact of an enhanced recovery programme for colorectal surgery in a public tertiary hospital in Singapore

Abstract

Objectives: The Enhanced Recovery After Surgery (ERAS) Programme is an approach to perioperative management of patients shown to lower complication rates and length of stay (LOS). Tan Tock Seng Hospital (TTSH) has been a member of the ERAS Society since March 2016 - one of the first two centres in Asia to implement the ERAS Programme. We review the clinical and financial impact of ERAS on patient outcomes after elective major colorectal surgery in our institution. Methods: Data collected in the ERAS Interactive Audit System for patients undergoing elective colorectal surgery from March 2016 to March 2017 was analyzed retrospectively. This was compared with data collected from January 2015 to December 2015 during the traditional care period. The primary outcome was postoperative length of stay (LOS). Secondary outcome measures were postoperative complications, readmission rates and cost savings. Further subgroup analysis was performed for patients with postoperative complications in both groups for LOS and cost savings. Results: 131 patients in the ERAS group were compared to 164 patients in the traditional care group. There were no significant difference in patient demographics between the groups. Patients in the ERAS group had a significantly shorter median LOS compared to the traditional care group (5 vs 7 days, p<0.01). There was no difference in overall complication rates between both groups (p= 0.48). Patients in the ERAS group had a significantly lower readmission rate compared to the traditional care group (4.6% vs 11%, p<0.01). Cost analysis showed a reduction in cost of $1070 per patient in the ERAS group. Subgroup analysis of patients with postoperative complications showed that those receiving traditional care stayed longer (Median LOS 11 vs 8 days, p<0.01). Cost savings in patients with postoperative complications was $3951 per patient in the ERAS group compared to those in the traditional care group. Conclusion: Implementation of ERAS Programme is associated with significantly shorter postoperative LOS and readmission rates. There was no significant difference in postoperative complications. Cost savings was also shown to be significant with ERAS care - this has significant savings for the healthcare system, especially in an environment of escalating healthcare costs. Disclosure of Interest: None declared.