ERAS 2.0: Continued Refinement of an Established Enhanced Recovery Protocol for Esophagectomy

Autor: Amit Katz, Carmen L. Mueller, Lorenzo E. Ferri, Yehonatan Nevo, Liane S. Feldman, Sarah Arjah, Jose Luis Ramírez García Luna, Jonathan Spicer, Jonathan Cools-Lartigue
Rok vydání: 2021
Předmět:
Zdroj: Annals of Surgical Oncology. 28:4850-4858
ISSN: 1534-4681
1068-9265
DOI: 10.1245/s10434-021-09854-7
Popis: We have previously demonstrated that implementing an enhanced recovery protocol (ERP) improved outcomes after esophagectomy. We sought to examine if, after a decade of an established ERP, further improvements in postoperative outcomes could be made after continually optimizing and revising the pathway. Patients undergoing esophagectomy for cancer from January 2019 to January 2020 were compared with our early-experience group within the initial ERP (June 2010–May 2011) and pre-ERP traditional care (June 2009–May 2010). The original ERP was initiated on June 2010 and underwent several revisions from 2014 to 2018, incorporating the following, amongst other elements: shorten the planned length of stay from 7 to 6 days, elimination of nasogastric tubes, use of soft closed-suction chest drains, and increased application of minimally invasive esophagectomy (MIE). Thirty-day outcomes (complications, length of stay, readmission) were compared for patients undergoing esophagectomy during the initial and most recent ERPs. Overall, 175 patients were identified; 47 underwent esophagectomy before ERP implementation (traditional care), 59 patients underwent esophagectomy after implementation of the original ERP, and 69 patients underwent esophagectomy after the most recent ERP (ERP 2.0). The groups were similar with respect to age, sex, and diagnosis. There were three times more MIEs in the ERP 2.0 group with a shorter median length of stay (7 [6–9] vs. 8 [7–17] vs. 10 [9–17]; p
Databáze: OpenAIRE
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