title: Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages.
abstract: BACKGROUND
  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.
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Tang
authors.forename: D J
authors.initials: DJ
authors.lastname: Humes
authors.forename: E
authors.initials: E
authors.lastname: Gemmil
authors.forename: N T
authors.initials: NT
authors.lastname: Welch
authors.forename: S L
authors.initials: SL
authors.lastname: Parsons
authors.forename: J A
authors.initials: JA
authors.lastname: Catton
mesh_terms: D000368:Aged; D019091:Critical Pathways / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000534:rehabilitation / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000534:rehabilitation / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000534:rehabilitation / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000534:rehabilitation; D011446:Prospective Studies; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome