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Cost impact analysis of enhanced recovery after minimally invasive gynecologic oncology surgery
  1. Cristina Mitric1,2,
  2. Sarah Daisy Kosa3,
  3. Soyoun Rachel Kim1,2,
  4. Gregg Nelson4,
  5. Stephane Laframboise1,2 and
  6. Geneviève Bouchard-Fortier1,2
  1. 1Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
  2. 2Department of Obstetrics and Gynaecology, Division of Gynecology Oncology, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Health Research Methods, Evidence, and Impacts, McMaster University, Hamilton, Ontario, Canada
  4. 4Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Geneviève Bouchard-Fortier, University Health Network, Toronto, Ontario, M5G 2C4, Canada; genevieve.bouchard-fortier{at}


Objective The implementation of a peri-operative care program based on enhanced recovery after surgery principles for minimally invasive gynecologic oncology surgery led to an improvement in same day discharge from 29% to 75% at our center. This study aimed to determine the program’s economic impact.

Methods Our initial enhanced recovery quality improvement program enrolled consecutive patients undergoing minimally invasive hysterectomy at a single center during a 12-month period and compared them to a pre-intervention cohort. The primary outcome was overall costs. The secondary outcomes were surgical and post-operative visit costs. The surgical visit costs included pre-operative and operating room, post-operative stay, pharmacy, and interventions costs. The 30-day post-operative visit costs included clinic and emergency room, and readmission costs. The costs for every visit were collected from the case-cost department and expressed in 2020 Canadian dollars (CAD).

Results A total of 96 and 101 patients were included in the pre- and post-intervention groups, respectively. The median total cost per patient for post-intervention was $7252 compared with $8381 pre-intervention (p=0.02), resulting in a $1129 cost reduction per patient. The total cost for the program implementation was $134 per patient for a total cost of $13 106. The median post-operative stay cost was $816 post-intervention compared with $1278 pre-intervention (p<0.05). Statistically significant savings for the post-intervention group were also found for operative visit, operating room costs, and pharmacy (p<0.05). On multivariate analysis, surgical approach was the only factor associated with operating room costs, whereas both surgical approach and group (pre- vs post-intervention) impacted the total and post-operative stay costs (p<0.05).

Conclusion In addition to increasing the same day discharge rate after minimally invasive gynecologic oncology surgery, an enhanced recovery-based peri-operative care program led to significant reductions in cost.

  • Laparoscopes
  • Gynecologic Surgical Procedures
  • Gynecology
  • Surgical Oncology
  • Hysterectomy

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors CM: conceptualization, data curation, investigation, methodology, statistical analysis, writing (original draft), guarantor. SDK: conceptualization, statistical analysis, writing (original draft). SRK: conceptualization, data curation, writing (review and editing). GN, SL: conceptualization, writing (review and editing). GB-F: conceptualization, investigation, methodology, project administration, supervision, writing (review and editing).

  • Funding This study was funded by Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario (MSU 19-019).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Paper presentation information: The findings were presented as an oral presentation at the Society of Gynecological Oncology of Canada 2022 annual meeting in June 2022, and as an e-poster at the International Gynecologic Cancer Society 2022 annual meeting in September 2022.