The financial impact of an enhanced recovery after surgery (ERAS) protocol in an academic gynecologic oncology practice

Gynecol Oncol. 2020 Feb;156(2):284-287. doi: 10.1016/j.ygyno.2019.11.017. Epub 2019 Nov 24.


Objective: To determine the financial impact of an enhanced recovery after surgery (ERAS) protocol in gynecologic oncology patients.

Methods: This study identified gynecologic oncology patients who were placed on the ERAS protocol after elective laparotomy from 10/2016-6/2017. A control group was identified from the year prior to ERAS implementation. Financial experts assisted in procuring data for these patient encounters, including payer status, direct and indirect costs, contribution margin, and length of stay (LOS). SPSS Statistics v. 24 was used for statistical analysis.

Results: 376 patients met criteria for inclusion: 179 in the ERAS group and 197 in the control group. Patient demographics were similar between the two cohorts. Payer status across the groups was not statistically significant in patients with private insurance (control 43.7% vs. ERAS 41.3%), Medicare (38.1% vs. 31.8%), or self-pay patients (12.2% vs. 15.1%). There was a significantly higher number of Medicaid patients in the ERAS group (6.1% vs. 11.7%; p = 0.05). Hospital direct costs ($5596 vs. 5346) and indirect costs ($5182 vs. $4954) per encounter were similar between groups. However, overall contribution margin per encounter decreased in the ERAS group ($11,619 vs. $8528; p = 0.01). LOS was significantly lower in the ERAS group (4.1 vs. 2.9 days; p = 0.04).

Conclusions: Implementation of the ERAS protocol in gynecologic oncology patients does not lead to increased costs for the patient or hospital system. The decreased contribution margin is likely due to a reduction in per diem payments caused by the reduction in LOS. On a per-patient-day basis, contribution margin was the same for both groups ($2877 vs $2857). The reduction in LOS also created capacity for additional cases, the financial impact of which was not evaluated.

MeSH terms

  • Case-Control Studies
  • Cohort Studies
  • Enhanced Recovery After Surgery
  • Female
  • Genital Neoplasms, Female / economics*
  • Genital Neoplasms, Female / surgery*
  • Gynecologic Surgical Procedures / economics*
  • Gynecologic Surgical Procedures / methods*
  • Gynecologic Surgical Procedures / standards
  • Health Expenditures / statistics & numerical data
  • Hospital Costs / statistics & numerical data
  • Humans
  • Insurance, Health
  • Length of Stay / economics
  • Medicaid / statistics & numerical data
  • Medicare / statistics & numerical data
  • Middle Aged
  • Perioperative Care / economics
  • Perioperative Care / methods
  • Perioperative Care / standards
  • Postoperative Care / economics
  • Postoperative Care / methods
  • Postoperative Care / standards
  • Retrospective Studies
  • United States