Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery

Br J Surg. 2013 Jul;100(8):1108-14. doi: 10.1002/bjs.9184.


Background: Enhanced recovery protocols may reduce postoperative complications and length of hospital stay. However, the implementation of these protocols requires time and financial investment. This study evaluated the cost-effectiveness of enhanced recovery implementation.

Methods: The first 50 consecutive patients treated during implementation of an enhanced recovery programme were compared with 50 consecutive patients treated in the year before its introduction. The enhanced recovery protocol principally implemented preoperative counselling, reduced preoperative fasting, preoperative carbohydrate loading, avoidance of premedication, optimized fluid balance, standardized postoperative analgesia, use of a no-drain policy, as well as early nutrition and mobilization. Length of stay, readmissions and complications within 30 days were compared. A cost-minimization analysis was performed.

Results: Hospital stay was significantly shorter in the enhanced recovery group: median 7 (interquartile range 5-12) versus 10 (7-18) days (P = 0·003); two patients were readmitted in each group. The rate of severe complications was lower in the enhanced recovery group (12 versus 20 per cent), but there was no difference in overall morbidity. The mean saving per patient in the enhanced recovery group was €1651.

Conclusion: Enhanced recovery is cost-effective, with savings evident even in the initial implementation period.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Clinical Protocols
  • Colorectal Surgery / economics*
  • Colorectal Surgery / rehabilitation
  • Conversion to Open Surgery
  • Cost Savings
  • Cost-Benefit Analysis
  • Counseling / economics
  • Female
  • Humans
  • Laparoscopy / economics
  • Laparoscopy / rehabilitation
  • Length of Stay / economics
  • Male
  • Patient Compliance
  • Perioperative Care / methods
  • Postoperative Complications / economics*
  • Postoperative Complications / rehabilitation
  • Recovery of Function
  • Severity of Illness Index