Cost-effectiveness of enhanced recovery pathway in bariatric surgery: It is not all about length of stay

Background: The goal of enhanced recovery pathways (ERP) is to optimize perioperative recovery and decrease variability of care between patients. Objectives: In this study, we aimed to assess the clinical and cost saving before and after implementation of an ERP program in bariatric surgery at our institution. Setting: Academic Center, United States. Methods: A pilot bariatric surgery ERP was implemented in June 2016. Demographic characteristics, outcomes, and technical direct costs of patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy were compared between the control group (January 2015 June 2016) and ERP group (July 2016 December 2017). Results: Two hundred fifty-two patients (118 [45%] in the control group and 144 [55%] in the ERP group) were included. Patient demographic characteristics were similar in both groups (P>.05). There were 2 (1.3%) reoperations within the ERP group but no mortalities. The median length of stay (LOS) was shorter in the ERP group by 1 day (P<.001) with comparable readmission rates. However, ERP implementation was associated with a 3.8% increase in costs for patients undergoing RYGB (P=.02). Finally, ERP protocol did not lead to an increase in either reoperation or readmission rates. Conclusion: ERP implementation decreases LOS without increasing adverse postoperative outcomes or readmissions. However, cost of care may increase for patients undergoing RYGB related to anesthesia and surgical services, which offset the gains noted by a decrease in LOS. Program implementing ERP need to focus on containing the costs of anesthesia care to realize financial benefits of ERP. (C) 2019 Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery.