Backgrounds: Enhanced recovery after surgery (ERAS) has revolutionised perioperative care in colorectal surgery with reduced length of stay (LOS), reduced complications and superior patient outcomes. Despite this, colorectal ERAS is still not the standard of care across Australia. A growing body of evidence shows that ERAS is associated with significant cost benefits; however, currently, there is a lack of Australian data. The aim of this study is to retrospectively compare the healthcare system costs for elective colorectal resections utilising ERAS compared with conventional perioperative management.
Methods: A single-centre, retrospective cohort study compared the total cost of an elective colorectal resection to the public healthcare system when utilising the 25 principles of ERAS versus conventional care (CC). The estimated cost of each elective resection was manually calculated, including preadmission, operation, postoperative and readmission costs between the years 2010 and 2022 with the introduction of ERAS at the start of 2015. Cost data were also cross-examined with patient outcomes to assess how variations in patient care impact costs.
Results: A total of 642 patients were included: 237 (36.9%) received conventional perioperative management, and 405 (63.1%) underwent ERAS. The use of ERAS resulted in a median cost reduction of 2010 AUD per patient (20,719 vs. 22,729 AUD, p = 0.008). Overtime, ERAS was associated with a downward cost trend each year as the program matured. This reduction in median cost was also demonstrated in a subgroup analysis of uncomplicated admissions (-961 AUD, p = 0.087) and in the presence of Grades I-II complications (-2049 AUD, p = 0.504); however, neither was statistically significant. The cost benefits of ERAS were not present in the presence of Grades III-V complications or when a patient was readmitted within 30 days. ERAS was associated with a reduced median LOS (5 vs. 6 days, p < 0.001) and a reduction in the overall complication rate (26.42% vs. 37.55%, p = 0.003), which was most appreciable in the reduced rates of Grades I-II complications (22.96% vs. 29.96%).
Conclusion: Colorectal ERAS resulted in a statistically significant reduction in the cost per patient for elective resections at an Australian public hospital. The reported cost benefits stem from the associated reduction in LOS and an improved overall complication rate, particularly in the rates of Grades I and II complications. Additionally, there was a downtrend in median cost each year as the ERAS program matured at this institution, with the potential for further benefit in future years.
© 2025 Royal Australasian College of Surgeons.