Central Surgical AssociationAn enhanced recovery pathway decreases duration of stay after esophagectomy
Section snippets
Methods
Patients undergoing esophagectomy for cancer or high-grade dysplasia at a single, high-volume, university-affiliated center from June 2009 to December 2011 were identified from a prospectively maintained database. Exclusion criteria included benign disease, emergency surgery, and pharyngolaryngoesophagectomies. Patients were categorized according to the date of their operation. An ERP was implemented on June 20, 2010. All patients undergoing preoperative evaluation after this date received
Results
A total of 113 esophagectomies were performed between June 2009 and December 2011, of which 106 met inclusion criteria for the study. Seven patients were excluded: 2 underwent pharygolaryngealesophagectomy, 2 were operated as emergencies, and 3 had benign disease. The 47 patients treated before June 10, 2010. received traditional care, and the next 59 patients were treated after initiation of the ERP. No patients were excluded from the pathway (Fig 2).
There were no differences identified
Discussion
The goal of an ERP is to identify and address factors that delay surgical recovery, principally represented by hospital discharge. Coordinated, multidisciplinary, evidence-based perioperative care plans require the active participation of all stakeholders. A recent Cochrane review concluded that clinical pathways are associated with a decrease in the rate of complications and improved documentation without negative impact on duration of stay and hospital costs.12 There is evidence for the
References (22)
- et al.
A hospital's annual rate of esophagectomy influences the operative mortality rate
J Gastrointest Surg
(1998) - et al.
Variation in esophagectomy outcomes in hospitals meeting leapfrog volume outcome standards
Ann Thorac Surg
(2011) - et al.
Fast tracking after Ivor Lewis esophagogastrectomy
Chest
(2004) - et al.
Esophagectomy–it's not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer
J Gastrointest Surg
(2007) - et al.
Systematic classification of morbidity and mortality after thoracic surgery
Ann Thorac Surg
(2010) - et al.
Patient perception of a clinical pathway for laparoscopic foregut surgery
J Gastrointest Surg
(2006) - et al.
Global cancer statistics
CA Cancer J Clin
(2011) - National Cancer Institute. Cancer trends progress report [cited 2012 Jan 27]. Available from:...
- et al.
Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005
Br J Cancer
(2009) - et al.
Surgeon volume and operative mortality in the United States
N Engl J Med
(2003)
Volume–outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000–2011
J Gastrointest Surg
Cited by (83)
The Predictive Value of Inflammatory Biomarkers in Esophageal Anastomotic Leaks
2021, Annals of Thoracic SurgeryCitation Excerpt :Removal of the thoracic drain occurs when a full diet is tolerated and drainage is less than 450 mL/24 hours. The planned discharge day was on POD6, although patients could leave earlier if appropriate.11,12 This protocol was established based on a previously published study of our local experience.11
Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit
2021, European Journal of Surgical OncologyDoes Timing of Robotic Esophagectomy Adoption Impact Short-Term Postoperative Outcomes?
2021, Journal of Surgical ResearchCitation Excerpt :In the field of colorectal surgery, adherence to ERAS protocols is associated with a decreased rate of postoperative complications and a shorter LOS, but there has been a mixed association with rate of unplanned readmissions.29,30 Although data are not as mature for perioperative protocols after esophagectomy, it seems as if the introduction of pathways in patients who underwent esophagectomy has also been shown to reduce LOS; however, these studies typically used nonstandardized protocols.31-34 Of note, previous analyses of postoperative pathways do not look specifically at the operative approach (open, thoracoscopic, or robotic), but rather look at esophagectomies as a whole.
Efficacy of 4 wk of home enteral feeding supplementation after esophagectomy on immune function: A randomized controlled trial
2020, NutritionCitation Excerpt :Single-blind clinical trial was performed in this RCTs because the jejunostomy tubes in SEN group were removed after discharge. The nutritional support pathway of the SEN group was based on the standardized protocol introduced by clinical nutrition guidelines in surgery [11–13]. Prolonged 1-mo HEN was implemented on the basis of the clinical and theoretical experience of our institution (Table 1).
Funded by an investigator-initiated research grant from Ethicon Endosurgery Canada. Dr Li receives salary support from the Surgeon Scientist program, Department of Surgery, McGill University. The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation is supported by a centre of excellence grant from Covidien Canada.