An enhanced recovery after surgery program for video-assisted thoracoscopic surgery anatomical lung resections is cost-effective.

Details

Serval ID
serval:BIB_76BA99A538E8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
An enhanced recovery after surgery program for video-assisted thoracoscopic surgery anatomical lung resections is cost-effective.
Journal
Journal of thoracic disease
Author(s)
Gonzalez M., Abdelnour-Berchtold E., Perentes J.Y., Doucet V., Zellweger M., Marcucci C., Ris H.B., Krueger T., Gronchi F.
ISSN
2072-1439 (Print)
ISSN-L
2072-1439
Publication state
Published
Issued date
10/2018
Peer-reviewed
Oui
Volume
10
Number
10
Pages
5879-5888
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Enhanced recovery after surgery (ERAS) programs have been reported to decrease complications and shorten hospital stays after lung resections, but their implementation requires time and financial investment with dedicated staff. The aim of this study was to evaluate the clinical and economic outcomes of video-assisted thoracoscopic surgery (VATS) anatomical pulmonary resections before and after implementation of an ERAS program.
The first 50 consecutive patients undergoing VATS lobectomy or segmentectomy for malignancy after implementation of an ERAS program were compared with 50 consecutive patients treated before its introduction. The ERAS protocol included preoperative counseling, reduced preoperative fasting with concomitant carbohydrate loading, avoidance of premedication, standardized surgery, anesthesia and postoperative analgesia, early removal of chest tube, nutrition and mobilization. Length of stay, readmissions and cardio-pulmonary complications within 30 days were compared. Total costs were collected for each patient and a cost-minimization analysis integrating ERAS-specific costs was performed.
Both groups were similar in terms of demographics and surgical characteristics. The ERAS group had significantly shorter postoperative length of stay (median: 4 <i>vs</i> . 7 days, P<0.0001), decreased pulmonary complications (16% <i>vs.</i> 38%; P=0.01) and decreased overall post-operative complications (24% <i>vs</i> . 48%, P=0.03). One patient in each group was readmitted and there was no 30-day mortality. ERAS-specific costs were calculated at €729 per patient including the clinical nurse and database costs. Average total hospitalization costs were significantly lower in ERAS group (€15,945 <i>vs</i> . €20,360, P<0.0001), mainly due to lower costs during the post-operative period (€7,449 <i>vs.</i> €11,454, P<0.0001) in comparison with the intra-operative period (€8,496 <i>vs</i> . €8,906, P=0.303). Cost-minimization analysis showed a mean saving in the ERAS group of €3,686 per patient.
An ERAS program for VATS anatomical lung resection is cost-effective and is associated with a lower complication rate and a shorter postoperative hospitalization.
Keywords
Pulmonary and Respiratory Medicine, Enhanced recovery, lobectomy, lung cancer, segmentectomy, thoracoscopy
Pubmed
Web of science
Create date
19/11/2018 17:59
Last modification date
20/08/2019 14:33
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