Background: 

Enhanced recovery after spine surgery (ERAS) is increasingly utilized to improve postoperative outcomes and reduce cost. There are limited data on the monetary benefits of ERAS when incorporating the costs of developing, operationalizing, and maintaining ERAS programs. The objective of this study was to calculate the incremental cost-effectiveness of a spine surgery ERAS program, modeling hospital and operational cost and length of stay (LOS).

Methods: 

The study included adult patients undergoing spine surgery before and after implementation of an ERAS program. Variables included individual patient-level and ERAS personnel costs, with LOS as the outcome utility of interest. Propensity score matching was used to create a quasi-experimental design to equate the standard care and ERAS groups.

Results: 

Four hundred and nine patients were included in the unmatched group, with 54 patients each in the standard care and ERAS groups after matching. In the matched cohort, the only imbalance in predictors (standard mean difference [SMD] >0.2) were race (SMD, 0.21), American Society of Anesthesiologist (ASA) physical status (SMD, 0.32), fluid balance in the operating room (SMD, 0.21), median (interquartile range) LOS (standard care, 2.0 [1.0, 3.75] days vs. ERAS, 4.0 [3.0, 5.0]; SMD, 0.81) and mean (±SD) total cost (standard care, $19,291.57±13,572.24 vs. ERAS, $24,363.45±26,352.45; SMD, 0.24). In the incremental cost effectiveness analysis, standard care was the dominant strategy in both 1-way and 2-way sensitivity analysis.

Conclusions: 

We report a real-world, cost-effectiveness analysis following implementation of an ERAS program for spine surgery at a quaternary medical center. Our study demonstrated that considering LOS as the sole determinant, standard care is the dominant cost-effective strategy compared with the ERAS protocol.

中文翻译：

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脊柱术后加速康复计划住院时间的增量成本效益分析：单中心、回顾性队列研究

背景： 

脊柱手术加速康复外科 (ERAS) 越来越多地用于改善术后效果并降低成本。当考虑到开发、实施和维护 ERAS 计划的成本时，关于 ERAS 的经济效益的数据有限。本研究的目的是计算脊柱手术 ERAS 计划的增量成本效益，对医院和运营成本以及住院时间 (LOS) 进行建模。

方法： 

该研究包括在实施 ERAS 计划之前和之后接受脊柱手术的成年患者。变量包括个体患者水平和 ERAS 人员成本，以及 LOS 作为感兴趣的结果效用。使用倾向评分匹配来创建准实验设计，以将标准护理组和 ERAS 组等同起来。

结果： 

未匹配组包括 409 名患者，匹配后标准护理组和 ERAS 组各有 54 名患者。在匹配队列中，唯一不平衡的预测因子（标准均差 [S​​MD] >0.2）是种族（SMD，0.21）、美国麻醉医师协会（ASA）身体状况（SMD，0.32）、手术室液体平衡（ SMD，0.21）、中位（四分位距）LOS（标准护理，2.0 [1.0，3.75] 天 vs. ERAS，4.0 [3.0，5.0]；SMD，0.81）和平均 (±SD) 总成本（标准护理，19,291.57 美元） ±13,572.24 对比 ERAS，$24,363.45±26,352.45；SMD，0.24）。在增量成本效益分析中，标准护理在单向和双向敏感性分析中都是主导策略。

结论： 

我们报告了在四级医疗中心实施脊柱手术 ERAS 计划后的真实成本效益分析。我们的研究表明，考虑到 LOS 作为唯一的决定因素，与 ERAS 协议相比，标准护理是占主导地位的成本效益策略。