Economic impact of enhanced recovery after surgery protocol in minimally invasive cardiac surgery

Abstract

Background ERAS (Enhanced Recovery After Surgery) is a multidisciplinary and integrative approach with the goal of optimizing the postoperative recovery. We aimed to analyze the economic impact of a newly established ERAS protocol in minimally invasive heart valve surgery at our institution. Methods ERAS protocol was implemented in 61 consecutive patients who were referred for elective minimally-invasive aortic or mitral valve surgery, between February 1, 2018 and March 31, 2019 ( ERAS-group ). Another 69 patients who underwent elective minimally-invasive heart valve surgery during the same time period were managed according to the hospital standards ( Control-group ). A detailed cost comparison analysis was carried out from a hospital perspective using a micro-costing approach. Results The total in-hospital stay was significantly shorter in the ERAS-group compared to the Control-group (6.1\u2009±\u20092.6 vs 7.7\u2009±\u20093.8\u2009days; p \xa0=\u20090.008) resulting in significant cost savings of €1087.2 per patient ( p \xa0=\u20090.003). Due to the intensified physiotherapy in the ERAS protocol, the costs for physiotherapy were €94.3 higher compared to the Control-group ( p \xa0<\u20090.001). The total costs in the ERAS cohort were €11,200.0\u2009±\u20093029.6/patient compared to € 13,109.8\u2009±\u20094527.5/patient in the Control-Group resulting in cost savings of €1909.8 patient due to the implementation of the ERAS protocol ( p \xa0=\u20090.006). Conclusion Implementation of an ERAS-protocol in minimally-invasive cardiac surgery can be carried out safely with a fast postoperative recovery of the patient. ERAS results in a financial benefit of up to €1909 per patient and therefore will play a key role in modern cardiac surgery in the near future.