Budget Impact Analysis of Perioperative Nutrition in Surgical Oncology Patients

OBJECTIVES: Implementation of Enhanced Recovery After Surgery (ERAS®) protocols including preoperative oral carbohydrate loading and early immunonutrition are associated with reduction in hospital length of stay (LOS).This analysis estimates the cost savings associated with implementing such ERAS protocols in colorectal, pancreaticoduodenectomy, distal pancreatectomy, gastric, and head and neck cancer surgical procedures.

METHODS: The model utilizes data from a retrospective analysis (Cochran et al, 2021) and meta-analysis (Drover et al, 2021) showcasing the reduction in LOS associated with the effect of perioperative nutrition in the five surgical procedures of interest. The cost of providing perioperative nutrition to surgical patients is weighed against cost savings associated with reducing the mean LOS. The 2019 Healthcare Cost and Utilization Project data was used to calculate average costs for inpatient episodes. Cost savings were estimated by comparing the total cost of care (adjusted to 2021 dollars) when utilizing perioperative nutrition versus not.

RESULTS: Perioperative nutrition is associated with a 11-34% reduction in LOS depending on the surgery type. Assuming 100 patients for each surgical procedure, an average hospital episode cost of $48,126, and $121 cost for perioperative nutrition, savings for colorectal procedures equate to $444,734. For pancreaticoduodenectomy and distal pancreatectomy procedures, savings equate to $2,184,468 and $1,175,379, respectively. Gastric procedures result in $925,754 savings while head and neck result in $409,719. Total savings equate to $5.1 million or average per patient savings of $10,280.

CONCLUSIONS: Perioperative nutrition can be a low-cost intervention to reduce post-operative LOS and hospital episode cost. More research is needed to examine the impact of perioperative nutrition not only on LOS but also on post-operative complications, 30-day hospital readmissions, and total healthcare utilization to enhance protocols implementing nutrition-focused care.