World Journal of Surgery

, Volume 43, Issue 3, pp 839–845 | Cite as

Enhanced REVENUE After Surgery? A Cost-Standardized Enhanced Recovery Pathway for Mastectomy Decreases Length of Stay

  • Robert S. Ackerman
  • Michael Hirschi
  • Brandon Alford
  • Trip Evans
  • John V. Kiluk
  • Sephalie Y. PatelEmail author
Original Scientific Report



Enhanced recovery after surgery (ERAS) protocols have been shown to improve surgical, anesthetic, and economic outcomes in intermediate-to-high-risk surgeries. Its influence on length of stay and cost of low-risk surgeries has yet to be robustly studied. As value-based patient care comes to the forefront of anesthesiology research, the focus shifts to strategies that maintain quality while effectively containing cost.


In July 2016, we implemented an ERAS for mastectomy protocol consisting of limiting fasting state, preoperative multimodal analgesia, and pectoralis I and II blocks. After 1 year, patient records were retrospectively reviewed for length of stay, opioid consumption, pain scores, and hospital charges.


Implementation of an ERAS protocol for mastectomies led to a decrease in opioid consumption, and statistically significant decrease in length of stay (1.19 vs. 1.44, p = 0.01). No significant change in hospital charges was observed ($25,787 vs. $25,863, p = 0.97); however, the variance of charges was significantly decreased (6.8 × 107 vs. 1.5 × 108, p = 0.002). The decrease in length of stay translated to an extra 100 hospital bed days which can provide up to an additional $2,100,000 in gross patient service revenue from additional mastectomy volume.


ERAS protocols for mastectomies may prove beneficial by allowing growing hospitals to increase bed capacity and consequently surgical volume. Despite no change in hospital charges, we predict a potential increase in gross patient service revenue of $2.1 million due to saved hospital bed days.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Robert S. Ackerman
    • 1
    • 2
  • Michael Hirschi
    • 1
  • Brandon Alford
    • 1
  • Trip Evans
    • 3
  • John V. Kiluk
    • 4
  • Sephalie Y. Patel
    • 3
    Email author
  1. 1.Morsani College of MedicineUniversity of South FloridaTampaUSA
  2. 2.Department of Anesthesiology and Pain ManagementUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Department of AnesthesiologyH. Lee Moffitt CancerTampaUSA
  4. 4.Department of Breast OncologyH. Lee Moffitt CancerTampaUSA

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