title: An enhanced recovery pathway decreases duration of stay after esophagectomy.
abstract: OBJECTIVE
  Enhanced recovery pathways (ERP) decrease morbidity and duration of stay after colorectal surgery. There is little information about their role in complex procedures, such as esophagectomy. The purpose of this study was to determine the impact of an ERP on duration of stay, complications, and readmissions after esophagectomy.
  
  
  METHODS
  Patients undergoing esophagectomy for cancer or high-grade dysplasia from June 2009 to December 2011 were identified from a prospectively maintained database. Beginning in June 2010, all patients were enrolled in a 7-day multidisciplinary ERP including written patient education with daily treatment plan, indications for intensive care admission, early structured mobilization, and diet and drain management. Short-term (30-day) outcomes were compared for patients undergoing esophagectomy pre- and post-pathway. Data are expressed as median values [interquartile range].
  
  
  RESULTS
  We identified 106 patients; 47 underwent esophagectomy before ERP implementation and 59 after. Patients were similar with respect to age, gender, diagnosis, and operative time. Hospital stay was shorter in the ERP group (8 [7-17] vs 10 [9-17] days; P = .01). There were no differences in rates of complications (59% vs 62%) or readmissions (6% vs 5%).
  
  
  CONCLUSIONS
  Implementation of a multidisciplinary ERP for esophagectomy was associated with decreased duration of stay, without an increase in complications or readmissions.
authors.affiliation: Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Chao
authors.initials: C
authors.lastname: Li
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Ferri
authors.forename: David S
authors.initials: DS
authors.lastname: Mulder
authors.forename: Annie
authors.initials: A
authors.lastname: Ncuti
authors.forename: Amy
authors.initials: A
authors.lastname: Neville
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lee
authors.forename: Pepa
authors.initials: P
authors.lastname: Kaneva
authors.forename: Debbie
authors.initials: D
authors.lastname: Watson
authors.forename: Melina
authors.initials: M
authors.lastname: Vassiliou
authors.forename: Franco
authors.initials: F
authors.lastname: Carli
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000368:Aged; D004935:Esophageal Diseases / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome