• Tarik Sammour, Kamran Zargar-Shoshtari, Abhijith Bhat, Arman Kahokehr, and Andrew G Hill.
• Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland, New Zealand. tsammour@middlemore.co.nz.
• N. Z. Med. J. 2010 Jul 30; 123 (1319): 61-70.

AimThere are few published ERAS cost-analyses in colorectal surgery. The aim of this paper is to evaluate whether costs saved by reduced postoperative resource utilisation would offset the financial burden of setting up and maintaining such an ERAS programme.MethodsA cost-effectiveness analysis from a healthcare provider perspective using a case-control model. The study group consisted of patients enrolled in the ERAS program for elective colonic surgery at Manukau Surgical Centre between December 2005 and March 2007. The control group consisted of consecutive patients from September 2004 to September 2005 (before the start of ERAS). Groups were matched with respect to operation, BMI, ASA, and Cr-POSSUM score.ResultsData were available for 50 patients in each group. There was a significant reduction in total hospital stay, intravenous fluid use, and duration of epidural use in the ERAS group. There were significantly fewer complications in the ERAS group. Implementation of ERAS cost approximately $NZ102,000, but this has been more than offset by costs saved in reduced postoperative resource utilisation, with an overall cost-saving of approximately NZ$6900 per patient.ConclusionImplementing an ERAS program is cost-effective in the medium term, with costs offset by those recovered by reduced resource utilisation in the postoperative period.

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