The impact of an enhanced recovery program (ERP) on the costs of colorectal surgery

Am J Surg. 2021 Jul;222(1):186-192. doi: 10.1016/j.amjsurg.2020.11.034. Epub 2020 Nov 19.


Background: Enhanced Recovery Programs (ERPs) benefit patients but their effects on healthcare costs remain unclear. This study aimed to investigate the costs associated with a colorectal ERP in a large academic health system.

Methods: Patients who underwent colorectal surgery from 2012 to 2014 (pre-ERP) and 2015-2017 (ERP) were propensity score matched based on patient and operative-level characteristics. Primary outcomes were median variable, fixed, and total costs. Secondary outcomes included length-of-stay (LOS), readmissions, and postoperative complications (POCs).

Results: 616 surgical cases were included. Patient and operative-level characteristics were similar between the cohorts. Variable costs were $1028 less with ERP. ERP showed savings in nursing, surgery, anesthesiology, pharmacy, and laboratory costs, but had higher fixed costs. Total costs between the two groups were similar. ERP patients had significantly shorter LOS (-1 day, p < 0.01), but similar 30-day readmission rates and overall POCs.

Conclusions: Implementation of an ERP for colorectal surgery was associated with lower variable costs compared to pre-ERP.

Keywords: Colorectal surgery; Cost analysis; ERP; Enhanced recovery; Financial impact; Value based.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Colectomy / adverse effects
  • Colectomy / economics*
  • Colectomy / statistics & numerical data
  • Costs and Cost Analysis / statistics & numerical data
  • Enhanced Recovery After Surgery*
  • Female
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Readmission / economics
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / prevention & control
  • Proctectomy / adverse effects
  • Proctectomy / economics*
  • Proctectomy / statistics & numerical data
  • Retrospective Studies