Implementing enhanced recovery after surgery programmes in a healthcare facility: issues and economic impacts.

For many specialties and operating techniques, enhanced recovery after surgery provides greater economic benefit if it is deployed across a whole healthcare institution rather than in just one or two departments. As with all innovations in the world of hospital care, the adoption of new procedures is a slow process because it is based on a consensual approach. To promote the dissemination and uptake of new practices at the local, national or institutional level, incentives must be developed and examples must be given. Successful deployment within a healthcare institution requires strategic adaptations in three areas: (i) the management of human resources dedicated to the patient pathway, (ii) a care unit architecture that facilitates working practices and patient management, and (iii) the use of digital tools and smart objects. Hospital decision-makers need to have a clear understanding of what is at stake, so that they can implement coordinated actions and encourage adoption. The investment required is hard to define because it results from a combination of skills and knowledge. At the institutional level, the return on investment is greater when the strategy is applied to all surgical specialties at once, since the structure can provide more care with fewer beds and fewer care units while maintaining the quality of patient management.

[The future, in France, of enhanced recovery after surgery seen from the economical perspective]. / L'avenir en France de la réhabilitation améliorée après chirurgie, vu sous l'angle médico-économique.

INTRODUCTION: The programmes of fast-track or enhanced recovery after surgery offer obvious advantages in terms of better postoperative outcomes and shorter hospital stay in many surgical specialties. However, the implementation of such programmes as strategic innovations has economic challenges that have not been well evaluated in a large scale, while they can influence the future of this innovation. METHODS: Simulation study was performed in 5 surgical units of digestive surgery, orthopaedics, and urologic surgery in the aim to help them to implement programmes of enhanced recovery. Several types of surgery were considered: colorectal, pancreatic, hepatic, hip, knee, shoulder, and bladder. All costs related to the implementation, hospitalisation (pre-, per-, and postoperative courses), and support of the project on the long-term, were calculated. RESULTS: The fixed and variable costs varied according to the surgical specialities. The calculation method allowed us to find that the gained standard value for one hospital-day was 180 €. The residual credit was as high as 202 000 € per year at the effective end of implementation in all surgical units, i.e. within 2-3 years. CONCLUSION: Beyond all medical advantages (namely better recovery for the patients, less postoperative morbidity, and reinforcement of the teamwork), the implementation of enhanced recovery programmes for high volume surgery will be cost-effective for our care units also in terms of health care performance.