Impact of the Eras Protocols on Costs and Benefits in Two Italian Second-Level Healthcare Centers According to the National Waiting List Management Plan (PNGLA)

Sep 30, 2026

To analyze the financial impact of the ERAS program in two major surgical procedures—colon resection for cancer and hip replacement—in two second-level healthcare centers. A cost–benefit analysis was performed on four hypothetical scenarios based on compliance with ERAS, quantifying additional costs and additional benefits linked to reduced length of hospital stay under the National Waiting List Management Plan (PNGLA). Revenue–cost ratios ranged from 2.92 in the most optimistic scenario to 1.11 in the least favorable scenario, remaining above 1 in all scenarios. ERAS is therefore feasible in second-level centers and supports a more sustainable health policy, improving the number of treated patients per year and reducing waiting list advantages.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

1. Introduction

Background and evolution of ERAS protocols

Phases and cost components of ERAS

Impact of prolonged length of stay on hospital flow

Evidence on LOS reduction and feasibility of same-day discharge

Telemedicine in ERAS follow-up

Italy’s COVID-19 recovery and implications for waiting times

Article Impact of the Eras Protocols on Costs and Benefits in Two Italian Second-Level Healthcare Centers According to the National Waiting List Management Plan (PNGLA) Francesco Frattini 1, *, Manrica Fabbi 1, Laura Bardelli 1, Federica Galli 1, Domenico Iovino 1, Linda Liepa 1, Marika Sharmayne Milani 1, Vincenzo Pappalardo 1, Franco Pavesi 1, Michele Surace 2, Luca Donnini 3, Diego Baù 3, Giovanni Poggialini 4, Paolo Covacich 4, Lorenzo Isella 4 and Stefano Rausei 1 Academic Editors: Sergio Huerta and Daniele Del Fabbro Received: 16 November 2025 Revised: 6 December 2025 Accepted: 30 December 2025 Published: 2 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21100 Varese, Italy 2 Department of Biotechnology and Life Sciences (DBSV), Insubria University, 21100 Varese, Italy 3 Orthopedics and Trauma Unit, Cittiglio-Angera Hospital, ASST Sette Laghi, 21100 Varese, Italy 4 Department of Operations Management, ASST Sette Laghi, 21100 Varese, Italy * Correspondence: [francescofrattini79@gmail.com](francescofrattini79@gmail.com) Abstract Background/Objectives: To analyze the financial impact of the ERAS program in two major surgical procedures (colon resection for cancer and hip replacement) in two second-level healthcare centers. Methods: A cost–benefit analysis was carried out on four hypothetical scenarios, based on the rate of compliance with the ERAS program, focusing on the additional costs and the additional benefits deriving from the decrease in hospital stay caused by the application of the ERAS protocol, with particular regard to the interventions envisaged by the National Waiting List Management Plan (PNGLA) . Results: In the most optimistic scenario, with a coefficient of application of ERAS of 100% and a number of 800 days of hospitalization gained per year, the revenue–cost ratio was equal to 2.92 . In the least favorable scenario, with a coefficient of application of ERAS of 50% and a number of 400 days of hospitalization gained per year, the revenue–cost ratio was equal to 1.11 . Conclusions: In all the scenarios, the revenue–cost ratio was higher than 1 . Implementation of the ERAS program is feasible also in second-level centers with the costs for additional healthcare professionals. Application of the ERAS program leads to a more sustainable health policy with an improvement in the number of treated patients per year and an advantage in the waiting list. Keywords: ERAS; colorectal surgery; hospitalization; healthcare 1. Introduction Enhanced recovery after surgery (ERAS) programs are a set of evidence-based practices spanning the perioperative period, designed to optimize postoperative outcomes by minimizing the physiological stress response and maintaining or rapidly restoring baseline function [1] . The concept that a structured, multimodal, multidisciplinary pathway can result in accelerated recovery after surgery first emerged in the early 2000s amongst patients undergoing colorectal surgery [2–4] . ERAS programs are now well-established in colorectal surgery, with the benefits over traditional care demonstrated by several meta-analyses of randomized controlled trials [5–8] . The first ERAS guidelines in colorectal surgery were published in 2005 [9] . Since the publication of the first ERAS colorectal guideline, a total of three subsequent sets of guidelines have been published. The current 2025 guideline reflects the collaborative efforts of the ERAS Society [10] . When comparing ERAS protocols with traditional care in colorectal surgery, ERAS significantly reduces the risk for postoperative morbidity and median length of stay (LOS) in the hospital. ERAS is a multimodal approach optimizing the preoperative phase, aiming for minimally i

FAQs

What is the purpose of the study on ERAS protocols?

The study analyzes the financial impact of the ERAS program for two major surgical procedures in two second-level healthcare centers, focusing on additional costs and benefits driven by reduced hospital stay.

How was cost–benefit effectiveness evaluated?

A cost–benefit analysis was carried out across four hypothetical scenarios based on the compliance rate with the ERAS program and the resulting hospitalization time gained.

What do the results suggest about implementing ERAS in second-level centers?

In all scenarios, the revenue–cost ratio exceeded 1, indicating that ERAS implementation is feasible in second-level centers while supporting a more sustainable policy, higher patient throughput, and improved waiting list outcomes.

Sep 30, 2026

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