Authors: GaëtanRomain Joliat Martin Hübner Markus Schäfer Nicolas Demartines
Publish Date: 2016/09/19
Volume: 40, Issue: 12, Pages: 3097-3097
Abstract
Implementation of ERAS programs is similar to other types of projects in the world of business you have to invest first and return on investment goes along with the later success if any For ERAS programs the return on investment is achieved by improvements in quality of care diminution of complications and reduction in length of stay and systematization of management As you mentioned the present study illustrates well the benefits of such programs and could serve as prove to convince more hospital managers to implement ERAS programsIt is true that costs of care are largely varying as reimbursements are mainly depending on the respective health care systems However it is not the absolute costs per se that are important but the difference between the costs in a cohort of ERAS patients compared to a cohort of nonERAS patients from a same institution To this end it is even secondary whether the observed differences are statistically significant Several studies showed the cost benefits of ERAS in different countries reinforcing the previous argument 1 2At first glance the MERCI equation seems attractive and simple to use We agree that prediction with personal and tailored data before investment is of importance In this regard the MERCI formula is a good suggestion as it may allow a rough guess on cost savings However some issues need be considered The MERCI equation is not referenced and has presently not been externally validated precluding largescale use The expected decrease in the complication rate can often not reliably be estimated prior to implementation of an ERAS program It is based on published data of the literature and often not originating from the same region or country Even though the Clavien classification allows a standardized reporting of postoperative complications it does not reference all complications in an individual patient Currently more holistic classifications such as the Comprehensive Classification Index could help to correct this issue 3 Moreover the MERCI equation does not take into account the durability of cost savings Indeed as described in our article the financial gain is per patient In consequence the more patients are treated within an ERAS program the more savings are done over time
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