[The future, in France, of enhanced recovery after surgery seen from the economical perspective].

Introduction: The programmes of fast-track or enhanced recovery after surgery offer obvious advantages in terms of better postoperative outcomes and shorter hospital stay in many surgical specialties. However, the implementation of such programmes as strategic innovations has economic challenges that have not been well evaluated in a large scale, while they can influence the future of this innovation.
Methods: Simulation study was performed in 5 surgical units of digestive surgery, orthopaedics, and urologic surgery in the aim to help them to implement programmes of enhanced recovery. Several types of surgery were considered: colorectal, pancreatic, hepatic, hip, knee, shoulder, and bladder. All costs related to the implementation, hospitalisation (pre-, per-, and postoperative courses), and support of the project on the long-term, were calculated.
Results: The fixed and variable costs varied according to the surgical specialities. The calculation method allowed us to find that the gained standard value for one hospital-day was 180 €. The residual credit was as high as 202 000 € per year at the effective end of implementation in all surgical units, i.e. within 2-3 years.
Conclusion: Beyond all medical advantages (namely better recovery for the patients, less postoperative morbidity, and reinforcement of the teamwork), the implementation of enhanced recovery programmes for high volume surgery will be cost-effective for our care units also in terms of health care performance.
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