Cost Impact of an Enhanced Recovery Program for Lower Extremity Bypass

Enhanced recovery programs (ERPs) have significant potential patient benefits. However, implementation can also lead to increased cost of care with addition standardized practices such as dedicated wound closure trays and use regional anesthesia. This study's aim was examine the impact ERP on for lower extremity bypass (LEB). A retrospective analysis performed LEB patients treated before (n = 145) after 171) in May 2018. Trauma, concomitant suprainguinal bypass, length stay (LOS) outliers were excluded. Clinical data McKesson-derived variable (volume dependent—supplies, nurse labor, medications), fixed independent—overhead, admin staff, building maintenance utilities), total costs analyzed over entire hospital encounter. Claudication, rest pain, or tissue loss similar between pre-ERP (P .335). Pre-ERP had compared ($28,881 vs $29,230; P .381). Overall median (interquartile range [IQR]) postoperative LOS decreased from 6 (IQR, 4-7 days) 4 days 3-7 < .001). Costs differed by indication, but there no difference cohorts (Table). When comparing centers, we observed declines nursing (−16.0%; .032), intensive unit (−56.5%; .021), therapy categories (−17.5%; .015) an increase surgical (14.6%; .008) anesthesia (14.8%; .004) (Figure). remained stable LEB-ERP. associated costs, likely owing additional elements dressings, trays, block utilization, these overall appear offset LOS.TablePre-enhanced program (ERP) costsCostPre-ERP 145)ERP 171)ERP/Pre-ERP differencePercent changeTotal costa$28,881 ± 1,3571$29,230 15,359$3491.2By indication Claudication$21,210 6585$23,149 10,496$19399.1 Rest pain$29,359 14516$29,194 15,082$ (165)−0.6 Tissue loss$36,591 13431$36,483 17,812$ (107)−0.3Intensive a >90th percentile excluded.aFixed found follow trends. Open table new tab