title: Effectiveness of an outpatient preoperative care bundle in preventing postoperative pneumonia among esophageal cancer patients.
abstract: BACKGROUND
  This historical case-control study examined the effectiveness of an outpatient preoperative care bundle on the incidence of postoperative pneumonia among patients with esophageal cancer.
  
  
  METHODS
  We implemented a preoperative care bundle that comprised 7 care procedures that previous studies had suggested to be effective for decreasing postoperative respiratory complications, infections, postoperative hospital stay, and mortality. The care bundle group included patients who underwent surgery after the care bundle was implemented, whereas the control group included those who underwent surgery before its implementation.
  
  
  RESULTS
  The incidence of postoperative pneumonia was 3.8% in the care bundle group (1/26) and 22.4% in the control group (48/214). A logistic regression model showed that implementation of the care bundle had a significant effect on prevention of postoperative pneumonia (odds ratio, 0.16; 95% confidence interval: 0.01-0.94) after controlling the following confounding factors: sex, blood urea nitrogen, amount of blood loss, recurrent laryngeal nerve palsy, and preoperative hospital stay.
  
  
  CONCLUSIONS
  Implementation of the procedures of the preoperative care bundle was shown to be effective for preventing postoperative pneumonia in patients with esophageal cancer.
authors.affiliation: National Cancer Center Department of Nursing Administration, Tokyo, Japan. Electronic address: thiramat@ncc.go.jp.
authors.forename: Tamae
authors.initials: T
authors.lastname: Hiramatsu
authors.affiliation: Department of Nutrition, Omori Red Cross Hospital, Tokyo, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: Department of Nutrition, Faculty of Nursing and Nutrition, Shukutoku University, Chiba, Japan.
authors.forename: Setsuko
authors.initials: S
authors.lastname: Kuwabara
authors.affiliation: Esophageal Surgery Division, Department of Surgery, National Cancer Center, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tachimori
authors.affiliation: National College of Nursing, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Nishioka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*
keywords: Care bundle; Esophageal cancer; Postoperative pneumonia; Preoperative nursing