The implementation and effectiveness of an enhanced recovery programme after oesophago-gastrectomy: a prospective cohort study.
BACKGROUND
Oesophageal resection is notoriously complicated and produces a cohort of patients prone to postoperative complications. Maintaining quality care demands a systematic approach to patient management yet postoperative recovery after oesophagectomy is often needlessly inefficient, heterogeneous and governed by the idiosyncrasies of the operating surgeon. Enhanced recovery after surgery (ERAS) programmes are now well established in colorectal surgery and here we describe the implementation and effectiveness of an ERAS programme for the postoperative management of Ivor Lewis oesophago-gastrectomy (ILOG).


METHODS
An ERAS programme was devised and implemented with the support of a dedicated in-hospital task-force. Three consultant surgeons allocated consecutive patients to the programme (ERAS) and outcomes were compared to consecutive patients not on the ERAS programme (non-ERAS) and a pre-ERAS cohort (pre-ERAS). Principal outcome measures were total length of stay (TLOS), Accordion postoperative complication grade and 30-day readmission rate.


RESULTS
75 patients were enrolled on the ERAS programme, 41 continued as a non-ERAS cohort and 80 consecutive pre-ERAS patients were identified. A significant improvement in median TLOS was observed in the ERAS group (10 days r.7-58) compared to pre-ERAS (13 days r. 8-57) (p = <0.001) and non-ERAS patients (13 days r.8-42) (p = <0.001). No significant difference in Accordion scores for postoperative complications or 30-day readmission rates were observed.


CONCLUSIONS
The introduction of an ERAS programme after ILOG can significantly reduce TLOS without jeopardising patient safety or clinical outcomes. The successful introduction of an ERAS programme requires full motivation and support from all team members including the patient.
Peninsula Oesophago-Gastric Surgery Unit, Level 7 Derriford Hospital, Plymouth PL6 8DH, Devon, UK.
S J
SJ
Ford
Peninsula Oesophago-Gastric Surgery Unit, Level 7 Derriford Hospital, Plymouth PL6 8DH, Devon, UK.
D
D
Adams
Peninsula Oesophago-Gastric Surgery Unit, Level 7 Derriford Hospital, Plymouth PL6 8DH, Devon, UK.
S
S
Dudnikov
Peninsula Oesophago-Gastric Surgery Unit, Level 7 Derriford Hospital, Plymouth PL6 8DH, Devon, UK.
P
P
Peyser
Peninsula Oesophago-Gastric Surgery Unit, Level 7 Derriford Hospital, Plymouth PL6 8DH, Devon, UK.
J
J
Rahamim
Peninsula Oesophago-Gastric Surgery Unit, Level 7 Derriford Hospital, Plymouth PL6 8DH, Devon, UK.
T J
TJ
Wheatley
Peninsula Oesophago-Gastric Surgery Unit, Level 7 Derriford Hospital, Plymouth PL6 8DH, Devon, UK.
R G
RG
Berrisford
Peninsula Oesophago-Gastric Surgery Unit, Level 7 Derriford Hospital, Plymouth PL6 8DH, Devon, UK. Electronic address: gsanders@nhs.net.
G
G
Sanders
D016629:Esophagectomy / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010359:Patient Readmission; D011182:Postoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome
Enhanced recovery; Oesophagectomy