Introduction/Background We evaluated the economic impact of Enhanced Recovery After Surgery (ERAS) in the high-volume gynecologic oncology (GO) surgery division of a Canadian hospital.

Methodology ERAS was implemented in the GO division of the Centre Hospitalier de l’Université de Montréal (CHUM) in 2017. Patients who received GO elective surgeries in 2015 (pre-ERAS) and 2019 (post-ERAS) were compared. All GO elective surgeries (extracted from patient files) performed in 2015 and 2019 at the CHUM were included (same-day discharge cases were excluded). Since hospitalization costs (main surgical episode and 30-day re-admission episode) were not available in patient’s files, they were imputed to each patient using a linear regression model calibrated on the CHUM’s financial database. Distinct models were evaluated for the cost of the main episode and the re-admission episode (dependent variables) based on LOS (day 0 versus other days; independent variables). Mean costs (2021 EURO) per patient were compared using a t-test (statistical significance was p<0.05).

Results A total of 675 and 536 patients were included in the study 2015 and 2019, respectively. Mean LOS for the main surgical episode was 3.9 days in 2015 and 3.2 days in 2019. Overall, 41 (6.1%) and 25 (4.7%) patients had a re-admission episode in 2015 (LOS=8.5) and 2019 (LOS=4.8), respectively. After imputation, the average cost (per patient) of a hospitalization was €9,361.20 in 2015 and €8,404.60 in 2019 (mean difference [MD]=956.60, p=0.003). For the main surgical episode, average costs were €8,980.78 in 2015 and €8,231.51 in 2019 (MD=749.26, p=0.012), respectively. For the re-admission episode, average costs were €6,251.12 and €3,711.05 (MD=2,540.07, p=0.017). After adjusting for a mean surgical volume of 606 patients per year, the total hospital savings were €579,697.87 in the first post-ERAS year.

Conclusion Implementation of ERAS protocol for gynecological oncological surgery significantly decreased costs.