Economic considerations of a connected tracking device after colorectal surgery

Dear Editor Promoting short stay after colorectal surgery is a priority to counteract continuously increasing costs in stressed healthcare systems1. Enhanced recovery pathways (ERPs) have been widely adopted as the standard of care due to their beneficial effect on morbidity, length of stay and cost2. To innovate surgery further in a short stay, or even outpatient environment, connected tracking solutions (CTSs) have been suggested as a way to facilitate follow-up after discharge, providing patients and care providers with an automated remote monitoring tool3. The present study aims to evaluate cost savings associated with the implementation of a CTS for colorectal surgery. Data from a recently published institutional retrospective cohort study focusing on benefits and limitation of CTSs during follow-up3 after discharge were reused. This series included consecutive adult patients undergoing elective colorectal surgery between February and December 2018 with systematic use of an mHealth app for post-discharge follow-up. The control group, which did not use CTS, included consecutive patients undergoing the same elective procedures at the same institution between January and August 2019, with the usual follow-up strategy. All patients had a mobile phone number and were treated within an established ERP4. Direct medical costs related to the stay were collected using a micro-costing approach: revenue (fee), margin generated for the hospital, length of stay, as well as readmission and rehospitalization were compared. Indirect or community costs were not considered. Univariable analysis was performed with Mann–Whitney U test or Student t test for continuous variables and Fischer’s exact test for categorical variables. Resampling via bootstrap t test was performed for cost analysis. In total, 86 patients were included, 43 in the connected tracking group and 43 in the control group (Table 1). The costs directly related to the mHealth app were 16 094 Euros or 375 Euros per patient. Four patients in the connected tracking group had a shorter stay than the lower limit of their respective diagnosis-related group (DRG) code and were categorized as low outliers. The reduction attributed by the SwissDRG prospective payment system to these cases totalled an income reduction of 17 604 Euros for the hospital. Comparison of demographic and surgical specifics and length of stay between patients using postoperative connected tracking and patients undergoing the same procedures without tracking Values in parentheses are percentages unless indicated otherwise; *values are mean(s.d.). ERAS, enhanced recovery after surgery; LOSop, length of postoperative hospital stay. Comparison of demographic and surgical specifics and length of stay between patients using postoperative connected tracking and patients undergoing the same procedures without tracking Values in parentheses are percentages unless indicated otherwise; *values are mean(s.d.). ERAS, enhanced recovery after surgery; LOSop, length of postoperative hospital stay. Cost comparison revealed a trend towards fewer expenses in the study group (15 387 (95 per cent c.i. 13 527 to 17 570) Euros versus 18 579 (95 per cent c.i. 16 087 to 21 186) Euros, P = 0.066). Although the revenue was similar (18 680 (95 per cent c.i. 17 803 to 20 440) Euros versus 19 144 (95 per cent c.i. 17 218 to 21 235) Euros; P = 0.735), the margin per patient generated for the hospital was significantly higher in the connected tracking group (3293 (95 per cent c.i. 1698 to 4927) Euros versus 565 (95 per cent c.i. 1475 to 2418) Euros; P = 0.045). The average length of stay was 1.5 days shorter for the connected group compared with the control group. Knowing that not all hospital days are economically equivalent, with early days being more expensive5, the beneficial impact of the institutional ERP may therefore be potentiated by the CTS during the more expensive early hospitalization period. Most countries around the world, including Switzerland, use a prospective payment system based on DRGs, with each DRG having a cost weight calculated annually on the basis of updated hospital cost data per case. Therefore, the gap between revenue and costs in the connected group will shrink with time, contributing to value-based competition. Logistic optimization should go hand in hand with clinical optimization. ERP implementation helping to elaborate tailored discharge protocols, actively tracking postoperative complications and delivering standardized information, may help to achieve an economic benefit from both the healthcare and society perspective. The results of this study have to be interpreted within the limitation of the small study sample and the study setting, where there is a longstanding ERP experience. Disclosure. The authors declare no conflicts of interest.