title: Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy.
abstract: BACKGROUND
  This study assessed the feasibility of a protocol-driven written clinical pathway for multidisciplinary postoperative management after oesophagectomy for oesophageal neoplasia, and examined whether the application of such a protocol could shorten hospital stay and reduce postoperative morbidity and mortality.
  
  
  METHODS
  Consecutive patients undergoing transthoracic oesophagectomy for oesophageal neoplasia were divided into those treated between 2003 and 2008 to whom a clinical pathway was applied for postoperative management (group 1), and a control group treated between 1998 and 2002 when no clinical pathway was applied (group 2).
  
  
  RESULTS
  There were 74 patients in each group. Morbidity rates were similar in the two groups: 31 per cent in group 1 and 38 per cent in group 2. There were more pulmonary complications in group 2 (23 versus 14 per cent; P = 0.025). One patient (1 per cent) in group 1 and four (5 per cent) in group 2 died after surgery (P = 0.010). The median (range) length of hospital stay was 9 (5-98) days for group 1 and 13 (8-106) days in group 2 (P = 0.012).
  
  
  CONCLUSIONS
  Use of a written clinical pathway in patients undergoing oesophageal resection significantly reduced pulmonary complications, postoperative mortality and hospital stay.
authors.affiliation: Department of General Surgery, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Munitiz
authors.forename: L F
authors.initials: LF
authors.lastname: Martinez-de-Haro
authors.forename: A
authors.initials: A
authors.lastname: Ortiz
authors.forename: D
authors.initials: D
authors.lastname: Ruiz-de-Angulo
authors.forename: P
authors.initials: P
authors.lastname: Pastor
authors.forename: P
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019091:Critical Pathways / Q000592:standards*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult