Enhanced Perioperative Care Decreases Cost After Major Spinal Surgery

Abstract

Abstract INTRODUCTION Enhanced recovery after surgery (ERAS) standardizes surgical care, reducing unnecessary variation. The goals are outcome improvement and secondarily cost reduction. METHODS Two comparison groups were made. First, a historical cohort of patients from prior to EPOC implentation was identified as the traditional care group (TRDC). Second, a concurrent cohort of patients that failed to make entry into EPOC, the no pathway care (NOPC). Costs were broken into direct A, B and indirect costs, and analyzed using 2-tailed t-tests. The TRDC cohort costs were adjusted for inflation. Length of stay was analyzed using student's t-test with equal variances not assumed. RESULTS A total of 620 patients had EPOC care. A total of 183 and 129 patients received TRDC or NOPC, respectively. Total cost decreased by $19344 after pathway in comparison to the TRDC group. Total cost decreased $5889 comparing EPOC to a concurrent NOPC group. Direct costs B, implant and supply, were similar between NOPC and EPOC; however, there was a small difference between TRDC and EPOC, possibly explained by the time difference in surgical care. There was a significant cost savings when comparing EPOC to TRDC and NOPC for other direct costs (A) of $11160 and $4102 respectively. Hospital length of stay was significantly lower in EPOC than in both TRDC and NOPC. Similarly EPOC patients had significantly lower intensive care length of stay than both TRDC and NOPC. CONCLUSION Implementation of an ERAS strategy such as EPOC decreases cost and length of stay in patients undergoing major spine surgery. Length of stay was significantly lowered at both the intensive care and overall hospital level. The implementation of an EPOC pathway also achieved direct, indirect, and total cost savings in elective major spine surgery.