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. 2013 Jul;95(5):323-8.
doi: 10.1308/003588413X13629960046039.

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

J Tang  1 , D J Humes, E Gemmil, N T Welch, S L Parsons, J A Catton
Affiliations

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

J Tang et al. Ann R Coll Surg Engl. 2013 Jul.

Abstract

Introduction: The high mortality and morbidity associated with resection for oesophagogastric malignancy has resulted in a conservative approach to the postoperative management of this patient group. In August 2009 we introduced an enhanced recovery after surgery (ERAS) pathway tailored to patients undergoing resection for oesophagogastric malignancy. We aimed to assess the impact of this change in practice on standard clinical outcomes.

Methods: Two cohorts were studied of patients undergoing resection for oesophagogastric malignancy before (August 2008 - July 2009) and after (August 2009 - July 2010) the implementation of the ERAS pathway. Data were collected on demographics, interventions, length of stay, morbidity and in-hospital mortality.

Results: There were 53 and 55 oesophagogastric resections undertaken respectively for malignant disease in each of the study periods. The median length of stay for both gastric and oesophageal resection decreased from 15 to 11 days (Mann-Whitney U, p<0.001) following implementation of the ERAS pathway. There was no significant increase in morbidity (gastric resection 23.1% vs 5.3% and oesophageal resection 25.9% vs 16.7%) or mortality (gastric resection no deaths and oesophageal resection 1.8% vs 3.6%) associated with the changes. There was a significant decrease in the number of oral contrast studies used following oesophageal resection, with a reduction from 21 (77.8%) in 2008-2009 to 6 (16.7%) in 2009-2010 (chi-squared test, p<0.0001).

Conclusions: The introduction of an enhanced recovery programme following oesophagogastric surgery resulted in a significant decrease in length of median patient stay in hospital without a significant increase in associated morbidity and mortality.

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Figures

Figure 1
Figure 1. Percentage of gastrectomy patients discharged by length of stay
Figure 2
Figure 2. Percentage of oesophagectomy patients discharged by length of stay
See this image and copyright information in PMC

References

    1. National Oesophago-Gastric Cancer Audit 2010. Leeds: NHS Information Centre; 2010.
    1. Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 2004; 10: 71–75. - PubMed
    1. Cerfolio RJ, Bryant AS, Bass CSet al Fast tracking after Ivor Lewis esophagogastrectomy. Chest 2004; 126: 1,187–1,194. - PubMed
    1. Zehr KJ, Dawson PB, Yang SC, Heitmiller RF. Standardized clinical care pathways for major thoracic cases reduce hospital costs. Ann Thorac Surg 1998; 66: 914–919. - PubMed
    1. Low DE, Kunz S, Schembre Det al Esophagectomy – it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg 2007; 11: 1,395–1,402. - PubMed

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