Assessing the Economic Benefit of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Cervical Deformity Patients: Is the Initial Additive Cost of Protocols Offset by Clinical Gains

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States
PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
OO

Oluwatobi Onafowokan

United Kingdom
JL

Jordan Lebovic, MD, MBA

Resident
NYU Langone Orthopedics
New York, New York, United States
PJ

Pawel Jankowski

United States
MJ

M. Burhan Janjua

United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

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Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Background: Enhanced Recovery After Surgery (ERAS) can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, the economic benefit of ERAS protocols has not been established.

Purpose: To assess the financial impact of Enhanced Recovery After Surgery (ERAS) protocols and cost-effectiveness in cervical deformity corrective surgery.

Methods: Operative CD patients ≥18yrs with complete pre-(BL) and up to 2-year(2Y) postop radiographic/HRQL data were stratified by enrollment in Standard-of-Care ERAS beginning in 2020. Differences in demographics, clinical outcomes, radiographic alignment targets, peri-operative factors and complication rates were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. QALY was calculated using NDI mapped to SF6D using validated methodology with 3% discount rate to account for residual decline to life expectancy.

Results: 270 patients were included (58.11 ± 11.97 years, 48% female, 29.13 ± 6.89 kg/m2. Of these patients, 54 (20.0%) received ERAS protocol recovery treatment post-operatively. ERAS- patients were significantly more likely to utilize opioids than ERAS+ patients (p=.016) at baseline. In terms of net savings Peri-operatively, ERAS+ patients also reported lower mean LOS overall (4.33 vs 5.84, p=.393), and were more likely to be discharged directly to home (χ2(1) = 4.974, p=.028). ERAS+ patients also required significantly lower doses of opiates post-operatively than ERAS- patients (p=.020). In terms of peri-operative complications, ERAS+ patients were less likely to develop neurological complications overall (p=.025). and less likely experience venous thromboembolic complications or be diagnosed with venous disease post-operatively (p=.025). By 2Y, ERAS+ were also significantly less likely to develop major complications (p=.040) overall, suffer instrumentation failure (p=.032), or require reoperation (p=.027). Per cost analysis, ERAS+ patients reported a significantly lower mean total 2Y cost of 33,829 USD compared to ERAS- patients at 36,951 (p <.001). Furthermore, ERAS+ patients trended towards greater life-expectancy 2Y QALYs gained versus ERAS- patients (.423 vs .368, p=.051), and demonstrated significantly lower costs at reoperation by 2Y (7050 USD vs 8110, p<.001). Controlling for age, surgical invasiveness, and deformity per BL TS-CL, ERAS+ patients below 70 years old were significantly more likely to achieve a cost-effective outcome by 2Y compared to their ERAS- counterparts (OR: 1.011 [1.001 – 1.999, p=.048].

Conclusions: Patients undergoing Enhanced Recovery After Surgery (ERAS) protocols experience lower operative times, length of stays, as well as lower rates of peri-and and post-operative complications. Subsequently, this study demonstrates that ERAS programs in ACD surgery demonstrate improved cost-effectiveness and reduced total cost by 2Y post-operatively. Due to the potential economic benefit of ERAS for patients, physicians and institutions should consider incorporation of ERAS into practice for eligible patients.