Is Enhanced Recovery Really Cost Effective for Vaginal Hysterectomy?
A comparison of pre and post implementation expenditures
A Bell, S Relph, V Sivashanmugarajan, K Munro, K Chegwidden, S Lloyd*, F Babashola, and W Yoong
Department of Obstetrics and Gynaecology, North Middlesex Hospital, London
Conclusion
 The use of an enhanced recovery protocol reduces the cost of elective vaginal hysterectomy.
 Despite demanding increased resources in pre-operative patient education and post-operative follow up, an enhanced recovery protocol reduces mean
length of stay and lowers catheter and vaginal pack usage.
Introduction
• In the current economic climate, enhanced
recovery after surgery (ERAS) and ambulatory
gynaecology programmes are an attractive
means of attempting to reduce costs associated
with elective surgery.
•The cost effectiveness of enhanced recovery
programmes has been ratified in other surgical
specialities, yet no data is currently available
establishing whether ERAS is cost effective in
benign gynaecology.
•We aimed to study the effect on cost of
introducing an enhanced recovery program for
vaginal hysterectomy.
•In calculating cost effectiveness we considered
factors which may both incur costs as well as
save them (Diagram 1)
Patient
education
programs
Diagram 1: Factors influencing cost effectiveness
Methods
•A retrospective case-control study:
45 vaginal hysterectomy ERAS cases
45 vaginal hysterectomy controls (prior to
implementation of ERAS)
• Comparison of costs of elective vaginal
hysterectomy before and after the implementation
of ERAS including differences in:
- Length of stay
- Usage of catheter and vaginal pack
- Readmission rates
- Need for pre-operative Gynaecology
school and support of specialist ERAS
nurse in enhanced recovery cases
Results
Expenditure for each ERAS patient was £200
lower (a 15.4% saving) than with traditional
management
•Average cost for an ERAS case was £1101.67
vs. £1302.13 in controls (see Chart 1)
Chart 1: Breakdown of costs
Results
ERAS program required additional expenditure due
to:
- monthly Gynaecology school (£30/patient)
- part time band 6 nurse (£14/patient)
• Overall, expenditure was reduced due to
- Lower catheter and vaginal pack usage
- 45.2% reduction in the mean length of stay
(23.5 vs. 42.9hrs)
• Non-significant differences in readmission rates
(6.7% vs. 0.0%, p>0.05) between groups.
References
1.J Minim Invasive Gynecol. 2005 Nov-Dec;12(6):494-501.
Outpatient vaginal hysterectomy is safe for patients and reduces institutional cost.
Levy BS, Luciano DE, Emery LL.
2. Colorectal Dis. 2006 Jul;8(6):506-13. The influence of
an enhanced recovery programme on clinical outcomes, costs and quality of life
after surgery for colorectal cancer. King PM, Blazeby JM, Ewings P, Longman
RJ, Kipling RM, Franks PJ, Sheffield JP, Evans LB, Soulsby M, Bulley SH, Kennedy RH.