Cost-effectiveness of Enhanced Recovery Versus Conventional Perioperative Management for Colorectal Surgery.

Abstract:

OBJECTIVE:To determine the cost-effectiveness of enhanced recovery pathways (ERPs) versus conventional care for patients undergoing elective colorectal surgery. BACKGROUND:ERPs for colorectal surgery are clinically effective, but their cost-effectiveness is unknown. METHODS:A multi-institutional prospective cohort cost-effectiveness analysis was performed. Adult patients undergoing elective colorectal resection at 2 university-affiliated institutions from October 2012 to October 2013 were enrolled. One center used an ERP, whereas the other did not. Postoperative outcomes were recorded up to 60 days. Total costs were reported in 2013 Canadian dollars. Effectiveness was measured using the SF-6D, a health utility measure validated for postoperative recovery. Uncertainty was expressed using bootstrapped estimates (10,000 repetitions). RESULTS:A total of 180 patients were included (conventional care: n = 95; ERP: n = 95). There were no differences in patient characteristics except for a higher proportion of laparoscopy in the ERP group. Mean length of stay was shorter in the ERP group (6.5 vs 9.8 days; P = 0.017), but there were no differences in complications or readmissions. Patients in the ERP group returned to work quicker and had less caregiver burden. There was no difference in quality of life between the 2 groups. The cost of the ERP program was $153 per patient. Overall societal costs were lower in the ERP group (mean difference = -2985; 95% confidence interval, -5753 to -373). The ERP had a greater than 99% probability of cost-effectiveness. The results were insensitive to a range of assumptions and subgroups. CONCLUSIONS:Enhanced recovery is cost-effective compared with conventional perioperative management for elective colorectal resection.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Lee L,Mata J,Ghitulescu GA,Boutros M,Charlebois P,Stein B,Liberman AS,Fried GM,Morin N,Carli F,Latimer E,Feldman LS

doi

10.1097/SLA.0000000000001019

subject

Has Abstract

pub_date

2015-12-01 00:00:00

pages

1026-33

issue

6

eissn

0003-4932

issn

1528-1140

journal_volume

262

pub_type

临床试验,杂志文章,多中心研究
  • Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis.

    abstract:OBJECTIVE:A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA:Secondary pancreatic infection is the major cause of death in patients with acute necrotizin...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00000658-199507000-00010

    authors: Luiten EJ,Hop WC,Lange JF,Bruining HA

    更新日期:1995-07-01 00:00:00

  • Pancreatic reg gene expression is inhibited during cellular differentiation.

    abstract:BACKGROUND AND OBJECTIVE:Factors that control pancreatic regenerating (reg I) gene expression are unknown, but it is believed that its expression may correspond with cellular differentiation. The authors recently demonstrated that reg I is expressed in AR42J, a rat acinar cell line whose state of differentiation can be...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199703000-00013

    authors: Zenilman ME,Magnuson TH,Perfetti R,Chen J,Shuldiner AR

    更新日期:1997-03-01 00:00:00

  • Modified technique of obturator bypass in failed or infected grafts.

    abstract::The obturator bypass graft operation can be performed in a moderately simplified manner by a technique that allows extension of indications for the procedure beyond situations in which sepsis is present in the groin. Long-term analysis of the results of the cases available for study indicates that the procedure may ve...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198303000-00015

    authors: Pearce WH,Ricco JB,Yao JS,Flinn WR,Bergan JJ

    更新日期:1983-03-01 00:00:00

  • Clinical behavior and prognostic factors of periampullary adenocarcinoma.

    abstract:OBJECTIVE:The authors evaluated the outcome and potential prognostic factors of 60 patients with surgically resected periampullary tumors. SUMMARY BACKGROUND DATA:Periampullary carcinomas exhibit different clinical behaviors according to their site of origin. There are no prognostic factors for deciding the type of su...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199511000-00005

    authors: Chan C,Herrera MF,de la Garza L,Quintanilla-Martinez L,Vargas-Vorackova F,Richaud-Patín Y,Llorente L,Uscanga L,Robles-Diaz G,Leon E

    更新日期:1995-11-01 00:00:00

  • Endovascular Repair of Blunt Thoracic Aortic Trauma is Associated With Increased Left Ventricular Mass, Hypertension, and Off-target Aortic Remodeling.

    abstract:BACKGROUND:Aortic elasticity creates a cushion that protects the heart from pressure injury, and a recoil that helps perfuse the coronary arteries. TEVAR has become first-line therapy for many aortic pathologies including trauma, but stent-grafts stiffen the aorta and likely increase LV afterload. OBJECTIVE:Test the h...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000003768

    authors: Kamenskiy A,Aylward P,Desyatova A,DeVries M,Wichman C,MacTaggart J

    更新日期:2020-01-03 00:00:00

  • Transluminal coronary angioplasty during saphenous coronary bypass surgery: a preliminary report.

    abstract::A previously described balloon tipped dilatation catheter has been used during revascularization surgery to dilate lesions which potentially could limit the runoff of the saphenous bypass grafts. A total of 34 lesions were dilated in 25 patients. Restudy of 12 patients (15 lesions) demonstrated positive results and no...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198002000-00017

    authors: Wallsh E,Franzone AJ,Clauss RH,Bruno MS,Steichen F,Stertzer SH

    更新日期:1980-02-01 00:00:00

  • Effect of intravascular volume expansion on renal function during prolonged CO2 pneumoperitoneum.

    abstract:OBJECTIVE:To evaluate whether intravascular volume expansion would improve renal blood flow and function during prolonged CO2 pneumoperitoneum. SUMMARY BACKGROUND DATA:Although laparoscopic living donor nephrectomies have a considerably reduced risk of complications for the donors, significant concerns exist regarding...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-200002000-00007

    authors: London ET,Ho HS,Neuhaus AM,Wolfe BM,Rudich SM,Perez RV

    更新日期:2000-02-01 00:00:00

  • Cytokine modulation of Na(+)-dependent glutamine transport across the brush border membrane of monolayers of human intestinal Caco-2 cells.

    abstract::Previous studies have demonstrated that Na(+)-dependent brush border glutamine transport is diminished in septic patients. To examine the potential regulation of this decreased transport by endotoxin, cytokines, or glucocorticoids, the human intestinal Caco-2 cell line was studied in vitro. Na(+)-dependent glutamine t...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199205000-00017

    authors: Souba WW,Copeland EM

    更新日期:1992-05-01 00:00:00

  • Angiopoietin-2, marker and mediator of endothelial activation with prognostic significance early after trauma?

    abstract:OBJECTIVE:To measure plasma levels of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and vascular endothelial growth factor (VEGF) early after trauma and to determine their clinical significance. BACKGROUND:Angiopoietins and VEGF play a central role in the physiology and pathophysiology of endothelial cells. Ang-2 ha...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e318162d616

    authors: Ganter MT,Cohen MJ,Brohi K,Chesebro BB,Staudenmayer KL,Rahn P,Christiaans SC,Bir ND,Pittet JF

    更新日期:2008-02-01 00:00:00

  • Conversion for Unfavorable Intraoperative Events Results in Significantly Worse Outcomes During Laparoscopic Liver Resection: Lessons Learned From a Multicenter Review of 2861 Cases.

    abstract:OBJECTIVE:To investigate the risk factors for conversion during laparoscopic liver resection and its effect on patient outcome in a large cohort of patients. Additional analysis of outcomes in patients who required conversion for unfavorable intraoperative findings and conversion for unfavorable intraoperative events w...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/SLA.0000000000002332

    authors: Halls MC,Cipriani F,Berardi G,Barkhatov L,Lainas P,Alzoubi M,D'Hondt M,Rotellar F,Dagher I,Aldrighetti L,Troisi RI,Edwin B,Abu Hilal M

    更新日期:2018-12-01 00:00:00

  • Reduction of Postoperative Wound Infections by Antiseptica (RECIPE)?: A Randomized Controlled Trial.

    abstract:OBJECTIVE:To evaluate whether intraoperative subcutaneous wound irrigation with 0.04% polyhexanide can reduce surgical site infection (SSI) in elective laparotomies compared to saline. BACKGROUND:SSI is a common complication after gastrointestinal surgery. To date, there is a lack of evidence whether subcutaneous woun...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/SLA.0000000000003645

    authors: Strobel RM,Leonhardt M,Krochmann A,Neumann K,Speichinger F,Hartmann L,Lee LD,Beyer K,Daum S,Kreis ME,Lauscher JC

    更新日期:2020-07-01 00:00:00

  • Carcinoid syndrome from gastrointestinal carcinoids without liver metastasis.

    abstract::Although patients with bronchial and ovarian carcinoid tumors can develop the carcinoid syndrome (diarrhea and/or flushing) in the absence of hepatic metastasis, it is believed that development of the carcinoid syndrome in patients with carcinoid tumors of gastrointestinal origin occurs only after the patient has hepa...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198207000-00008

    authors: Feldman JM,Jones RS

    更新日期:1982-07-01 00:00:00

  • Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis.

    abstract::The aim of this study was to compare the immediate postoperative results and the long-term outcome of ileal pouch-anal anastomosis in 94 patients with familial adenomatous polyposis to those in 758 patients with ulcerative colitis. Two colitis patients died after operation (0.3%), but no polyposis patients died. Overa...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198909000-00002

    authors: Dozois RR,Kelly KA,Welling DR,Gordon H,Beart RW Jr,Wolff BG,Pemberton JH,Ilstrup DM

    更新日期:1989-09-01 00:00:00

  • What Promotes Surgeon Practice Change? A Scoping Review of Innovation Adoption in Surgical Practice.

    abstract:OBJECTIVE:The goal of this scoping review was to summarize the literature on facilitators and barriers to surgical practice change. This information can inform research to implement best practices and evaluate new surgical innovations. BACKGROUND:In an era of accelerated innovations, surgeons face the difficult decisi...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000004355

    authors: Arroyo NA,Gessert T,Hitchcock M,Tao M,Smith CD,Greenberg C,Fernandes-Taylor S,Francis DO

    更新日期:2020-08-26 00:00:00

  • Acute hemorrhagic pancreatitis and pseudocyst due to mumps.

    abstract::This is the first reported case of mumps hemorrhagic pancreatitis in a child, documented at operation, and by rising mumps titers and complicated by a pseudocyst. In severe cases when surgery is indicated, drainage of the lesser sac usually prevents pseudocyst formation. If a pseudocyst occurs, drainage is required to...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197407000-00012

    authors: Feldstein JD,Johnson FR,Kallick CA,Doolas A

    更新日期:1974-07-01 00:00:00

  • Transvaginal natural orifice translumenal endoscopic surgery cholecystectomy: early evolution of the technique.

    abstract:INTRODUCTION:Initial excitement for Natural Orifice Transluminal Endoscopic Surgery (NOTES) has been partly tempered by the reality that a NOTES procedure without laparoscopic or needleoscopic-assistance has not been performed by most groups. After safely performing laparoscopically-assisted transvaginal cholecystectom...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章

    doi:10.1097/SLA.0b013e3181a802e2

    authors: Gumbs AA,Fowler D,Milone L,Evanko JC,Ude AO,Stevens P,Bessler M

    更新日期:2009-06-01 00:00:00

  • Single-port donor nephrectomy provides improved patient satisfaction and equivalent outcomes.

    abstract:OBJECTIVE:Minimally invasive techniques have expanded the donor pool for living kidney donation. We changed our approach to single-port donor nephrectomy in 2009 and have compared outcomes with traditional multiple-port laparoscopic donor nephrectomy. BACKGROUND:The development of minimally invasive surgical technique...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e318262ddd6

    authors: Barth RN,Phelan MW,Goldschen L,Munivenkatappa RB,Jacobs SC,Bartlett ST,Philosophe B

    更新日期:2013-03-01 00:00:00

  • Do Surgeons React?: A Retrospective Analysis of Surgeons' Response to Harassment of a Colleague During Simulated Operating Theatre Scenarios.

    abstract:OBJECTIVE:To assess and report on surgeons' ability to identify and manage incidences of harassment. BACKGROUND:The Royal Australasian College of Surgeons is committed to driving out discrimination, bullying, harassment, and sexual harassment from surgical training and practice, through changing the culture of the wor...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000002434

    authors: Gostlow H,Vega CV,Marlow N,Babidge W,Maddern G

    更新日期:2018-08-01 00:00:00

  • Effect of resection margins on the recurrence of Crohn's disease in the small bowel. A randomized controlled trial.

    abstract:OBJECTIVE:The authors assess the effect of surgical margin width on recurrence rates after intestinal resection of Crohn's Disease (CD). BACKGROUND:The optimal width of margins when resecting DC of the small bowel is controversial. Most studies have been retrospective and have had conflicting results. METHODS:Patient...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000658-199610000-00014

    authors: Fazio VW,Marchetti F,Church M,Goldblum JR,Lavery C,Hull TL,Milsom JW,Strong SA,Oakley JR,Secic M

    更新日期:1996-10-01 00:00:00

  • Cancer-associated venous thrombosis in the surgical setting.

    abstract:OBJECTIVE:Cancer patients are at a relatively high risk of venous thromboembolism (VTE), and this has implications for surgical outcome. DATA SOURCE:English literature search including the keywords cancer, surgery and VTE was undertaken to review the risk, etiology, prevention and treatment of VTE in surgical oncology...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e318195c50c

    authors: Behranwala KA,Williamson RC

    更新日期:2009-03-01 00:00:00

  • Surgical management of carcinoma of the junction of the main hepatic ducts.

    abstract::Twenty-six patients are reviewed who had primary carcinomas involving the junction of the hepatic ducts. The majority had had an initial procedure of palliative biliary diversion elsewhere and were referred for further treatment. In three cases, en bloc resection of the tumor with total hepatectomy and orthotopic live...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197607000-00012

    authors: Fortner JG,Kallum BO,Kim DK

    更新日期:1976-07-01 00:00:00

  • Repeat hepatectomy for colorectal liver metastases.

    abstract:OBJECTIVE:The authors assess the long-term results of repeat hepatectomies for recurrent metastases of colorectal cancer and determine the factors that can predict survival. SUMMARY BACKGROUND DATA:Safer techniques of hepatic resection have allowed surgeons to consider repeat hepatectomy for colorectal metastases in a...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199701000-00006

    authors: Adam R,Bismuth H,Castaing D,Waechter F,Navarro F,Abascal A,Majno P,Engerran L

    更新日期:1997-01-01 00:00:00

  • Impact of Weekday of Esophagectomy on Short-term and Long-term Oncological Outcomes: A Nationwide Population-based Cohort Study in the Netherlands.

    abstract:OBJECTIVE:The aim of this study was to determine whether weekday of esophagectomy impacts 30-day mortality, and short- and long-term oncologic outcomes in esophageal cancer. SUMMARY OF BACKGROUND DATA:Recent literature suggests a relationship between the weekday of esophagectomy and overall survival. This finding coul...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000001909

    authors: Visser E,van Rossum PSN,Verhoeven RHA,Ruurda JP,van Hillegersberg R

    更新日期:2017-07-01 00:00:00

  • Chest Wall Resection for Recurrent Breast Cancer in the Modern Era: A Systematic Review and Meta-analysis.

    abstract:OBJECTIVE:To review the literature on chest wall resection for recurrent breast cancer and evaluate overall survival (OS) and quality-of-life (QOL) outcomes. BACKGROUND:Full-thickness chest wall resection for recurrent breast cancer is controversial, as historically these recurrences have been thought of as a harbinge...

    journal_title:Annals of surgery

    pub_type: 杂志文章,meta分析

    doi:10.1097/SLA.0000000000002310

    authors: Wakeam E,Acuna SA,Keshavjee S

    更新日期:2018-04-01 00:00:00

  • Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial.

    abstract:OBJECTIVE:To determine if the extent of lymphadenectomy (number of recovered lymph nodes) was associated with long-term outcome in patients operated on for stage B and C colon cancer. SUMMARY BACKGROUND DATA:Lymphatic spreading is the main prognostic indicator in colon cancer patients, although the optimal extent of l...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/00000658-200204000-00002

    authors: Prandi M,Lionetto R,Bini A,Francioni G,Accarpio G,Anfossi A,Ballario E,Becchi G,Bonilauri S,Carobbi A,Cavaliere P,Garcea D,Giuliani L,Morziani E,Mosca F,Mussa A,Pasqualini M,Poddie D,Tonetti F,Zardo L,Rosso R

    更新日期:2002-04-01 00:00:00

  • Neurokinin-2 receptor levels correlate with intensity, frequency, and duration of pain in chronic pancreatitis.

    abstract:OBJECTIVE:Generation and maintenance of pain in chronic pancreatitis (CP) have been shown to be partially attributable to neuroimmune interactions, which involve neuropeptides such as substance P (SP). So far, expression of SP receptors NK-2R, NK-3R, the SP-encoding gene preprotachykinin A (PPT-A), and the SP degradati...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e318070d56e

    authors: Michalski CW,Shi X,Reiser C,Fachinger P,Zimmermann A,Büchler MW,Di Sebastiano P,Friess H

    更新日期:2007-11-01 00:00:00

  • Effects of superoxide dismutase and allopurinol on the survival of acute island skin flaps.

    abstract::We have demonstrated previously that oxygen-derived free radicals are important mediators of tissue injury following ischemia (total venous occlusion) and reperfusion in small (3 cm X 6 cm) island skin flaps in rats. In this study, we evaluated extension of this concept to regional ischemia in large (8 cm X 8 cm) acut...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198503000-00018

    authors: Im MJ,Manson PN,Bulkley GB,Hoopes JE

    更新日期:1985-03-01 00:00:00

  • The Australian and New Zealand Audit of Surgical Mortality-birth, deaths, and carriage.

    abstract:OBJECTIVE:This article outlines the formation of the Australian and New Zealand Audit of Surgical Mortality (ANZASM) and describes its objectives, governance, functioning and challenges. BACKGROUND:A nationwide audit of surgical mortality provides an overview of the leading causes of death in patients who require surg...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000000581

    authors: Raju RS,Guy GS,Majid AJ,Babidge W,Maddern GJ

    更新日期:2015-02-01 00:00:00

  • Caloric restriction increases the expression of heat shock protein in the gut.

    abstract:OBJECTIVE:The authors determined whether caloric restriction (CR) either acutely or chronically, alters heat shock protein 70 (hsp70) gene expression in the gut. SUMMARY BACKGROUND DATA:Caloric restriction prolongs the life span and delays age-related disease (e.g., cancer) in mammals; the mechanisms responsible for t...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199605000-00015

    authors: Ehrenfried JA,Evers BM,Chu KU,Townsend CM Jr,Thompson JC

    更新日期:1996-05-01 00:00:00

  • The pregnant motor vehicle accident casualty: adherence to basic workup and admission guidelines.

    abstract:OBJECTIVE:To investigate the workup/treatment provided to pregnant motor vehicle accident (MVA) casualties in a mature trauma system. Adherence to recommendations was used to measure quality of care. BACKGROUND:MVAs affect approximately 3% of pregnant women. Trauma casualty outcome improves after implementation of gui...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e31822638d4

    authors: Sela HY,Weiniger CF,Hersch M,Smueloff A,Laufer N,Einav S

    更新日期:2011-08-01 00:00:00