Colorectal ERP improves outcomes, lowers costs despite use of expensive drugs

Editor's Note

Implementation of an enhanced recovery pathway (ERP) for colorectal surgical patients substantially reduced length of stay, total hospital costs, and direct pharmacy costs without increasing complications or readmission rates in this study.

The study, which included 160 colorectal patients before ERP was implemented and 146 patients after implementation, found that for the ERP group:

• Hospital length of stay was 2 days shorter.
• Fewer patients had lack of normal bowel function (6% vs 20%).
• Patients were able to discontinue pain medication 1 day after surgery compared to 3 days for the other group.
• Use of narcotics was reduced (212 vs 720 morphine equivalent units).

Total direct costs were $1,717 lower per patient in the ERP group, and daily pharmacy costs per patient were higher ($477 vs $318). However, total pharmacy costs were $325 less in the ERP group.

Though high pharmaceutical costs associated with ERP regimens have been a significant barrier to widespread implementation, this study shows that ERP decreased total pharmacy costs and the total cost of hospitalization. Widespread implementation of ERPs has the potential for a huge impact on healthcare costs, the authors say.

Enhanced recovery pathways (ERPs) aim to reduce length of stay without adversely affecting
short-term outcomes. High pharmaceutical costs associated with ERP regimens, however,
remain a significant barrier to widespread implementation. We hypothesized that ERP
would reduce hospital costs after elective colorectal resections, despite the use
of more expensive pharmaceutical agents.

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