Better clinical benefits and potential cost saving of an enhanced recovery pathways for laparoscopic adrenalectomy

Background: Enhanced recovery pathways (ERPs) have been demonstrated to be clinically and economically effective for colorectal surgery. However, data are lacking to support the cost-effectiveness of ERPs for laparoscopic adrenalectomy, as well as potential economic loss. This study aims to determine the cost-effectiveness of ERPs vs. conventional care (CC) for patients undergoing laparoscopic adrenalectomy. Methods: A single centered retrospective case-control study was performed. Patients undergoing laparoscopic adrenalectomy from January 2018 to June 2021 were enrolled. One inpatient ward used ERPs, whereas the other did not. Case control was used for matching (53 patients for each group). Postoperative outcomes were recorded up to 30 days after surgery. ERPs-specific costs were integrated into the model. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration, which were reported in Renminbi. A bootstrap independent t-test was used for comparison. Results: The two groups were matched in terms of demographics and surgical details. Hospital stay was significantly shorter in the ERPs group (2.54 days, P<0.001). The rate of complications was lower in the ERPs group (1 vs. 7 patients, P=0.031), there was no severe complications or morbidity. ERPs-specific costs were (sic)656 per patient. The self-payment cost difference per patient between the two groups was (sic)3,154.52 in favor of the ERPs group, but this was not statistically significant (P=0.113). The mean direct saving per patient in the ERPs group was (sic)8,326.00, the total costs saving including indirect and potential overhead per patient was (sic)18,247.60. Conclusions: Enhanced recovery is cost-effective compared with conventional perioperative management for laparoscopic adrenalectomy. Savings were noted in disposable materials, medicine and medical services, radiology and laboratory costs, with no increase in morbidity or duration.