World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://www.wjon.org

Original Article

Volume 14, Number 5, October 2023, pages 401-405

Improving Value in Colorectal Cancer Care: An Economic Analysis of Enhanced Recovery Protocols at a Community Hospital

Figures

Figure 1.
Figure 1. Enhanced recovery protocols showing a significant reduction in costs for each DRG code at a community hospital. X-axis is showing the Diagnostic Related Criteria; Y-axis is showing financial cost in US dollars ($) spent for a case with the corresponding average length of stay. *Reduction in costs per patient ($), P = 4.39 × 10-4. **Reduction in costs per patient ($), P = 2.72 × 10-22. ***Reduction in costs per patient ($), P = 4.19 × 10-20. ERP: enhanced recovery protocol.
Figure 2.
Figure 2. Average length of stay (LOS) is significantly reduced in patients undergoing the enhanced recovery protocols, represented by the light blue columns. Green columns are showing the number of spared hospitalization days in a patient undergoing the enhanced recovery after surgery (ERAS) protocol at a community hospital. X-axis corresponds to the Diagnostic Related Criteria (DRG) group; Y-axis is showing the LOS in days. *Reduction in LOS (days): 13.08 vs. 3.37, P = 6.99 × 10-5. **Reduction in LOS (days): 10.86 vs. 4.58, P = 1.31 × 10-7. ***Reduction in LOS (days): 7.27 vs. 3.34, P = 0.004. ERP: enhanced recovery protocol.

Tables

Table 1. Descriptions of DRG Codes Used to Identify Disease Classifications
 
DRGDescription of DRG code
DRG: Diagnostic Related Group.
DRG 329Major bowel surgery with major complication or comorbidities
DRG 330Major bowel surgery with comorbid conditions
DRG 331Major bowel surgery without comorbid conditions

 

Table 2. Perioperative Interventions in ERP Versus Non-ERP Protocol
 
ERPNon-ERP
ERP: enhanced recovery protocol; DVT: deep venous thrombosis; NGT: nasogastric tube; IV: intravenous.
Perioperative interventions
  Counseling and educationPatient was provided counseling, booklet, and YouTube video on recovery program. Pre-habilitation initiatedAt discretion of surgeon
  Fluids and fastingFluid carbohydrate loading until 2 h before surgery. No solids foods after midnightNo fluids or solid food allowed after midnight before surgery
  Bowel preparationMinimal bowel preparationAt discretion of surgeon
  ProphylaxisDVT, infection, and hypothermia prophylaxis as per guidelinesDVT, infection, and hypothermia prophylaxis as per guidelines
Intraoperative interventions
  AnalgesiaMultimodal analgesia with no or short-acting premedication, minimal sedation and narcotics, routine use of nerve blocksAt discretion of surgeon
  NGTSparing use of NGT, early removal postoperativelyRoutine use at discretion of surgeon
  Urinary catheterSparing use of Foley, early removal postoperativelyRoutine use at discretion of surgeon
  DrainSparing use of drain, early removal postoperativelyRoutine use at discretion of surgeon
  Surgical approachMinimally invasive: laparoscopic/roboticMinimally invasive: laparoscopic/robotic
  Intravenous fluidsAvoid salt and water overload, minimal administration, dependent on operationAt discretion of surgeon
  Hypothermia preventionActive warm air blanketActive warm air blanket
Postoperative interventions
  AnalgesiaMultimodal with minimal opioidsAt discretion of surgeon
  MobilizationEarly and frequentAt discretion of surgeon
  NutritionEarly oral nutrition, gum chewingAt discretion of surgeon
  IV fluidsMinimal IV fluid hydrationAt discretion of surgeon