SP09. Financial Impact of an Enhanced Recovery After Surgery (ERAS) Protocol for Cranial Vault Remodeling Procedures

PURPOSE: ERAS protocols have been shown to decrease opiate use and length of stay in pediatric plastic surgery postoperative patients. ERAS protocols have also been shown to be cost effective across many different adult subspecialties including microsurgical breast reconstruction. This study examines the financial impact of an ERAS protocol for cranial vault remodeling procedures. METHODS: After Institutional Review Board approval, data on all patients undergoing a cranial remodeling procedure for craniosynostosis at the authors’ institution over a 11-year period were collected. Charges were analyzed for operating room (OR), anesthesia, intensive care unit (ICU) stay, non-ICU stay, and total overall costs along with other data such as procedure length. Costs were appropriately adjusted for inflation. Financial data for patients who received surgery prior to implementation of the ERAS protocol (pre-ERAS group, n =57) was compared to those that followed the ERAS protocol (ERAS group, n = 131). A sub-analysis was performed on patients that received a fronto-orbital advancement (FOA) (pre-ERAS n = 19, ERAS n = 51) as this was the most commonly performed surgery during both time periods and would control for other variables. Independent t-tests were utilized with a significance value of 0.05. RESULTS: During this time period there were 188 patients that met criteria. There was no significant difference between the pre-ERAS and ERAS groups on any of the examined costs. When examining patients who received FOA, there was a nearly $24,000 decrease in OR costs (p<0.01), a $1,700 decrease in anesthesia costs (p<0.01), and an insignificant $18,400 decrease in total cost (p=0.12). There was an insignificant increase in non-ICU hospital stay ($7,000, p=0.33). Though ICU length of stay was shortened (27 hours vs 41 hours), the cost did not differ as ICU costs are generated per 24-hour day. CONCLUSION: Standardized ERAS protocols for patients undergoing FOA for craniosynostosis can help decrease OR costs and operative times, though this study showed no significant difference in total expenses. The decrease in OR costs and anesthesia costs are likely attributed to a standardized protocol that has been agreed upon prior to the day of surgery.