title: Impact of a Fast-track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges.
abstract: OBJECTIVE
  To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges.
  
  
  BACKGROUND
  FTEP involved transferring patients to the telemetry unit instead of the surgical intensive care unit (SICU) after esophagectomy.
  
  
  METHODS
  We retrospectively reviewed 708 consecutive patients who underwent esophagectomy for primary esophageal cancer during the 4 years before (group A; 322 patients) or 4 years after (group B; 386 patients) the institution of an FTEP. Postoperative morbidity and mortality, LOS, and hospital charges were reviewed.
  
  
  RESULTS
  Compared with group A, group B had significantly shorter median LOS (12 days vs 8 days; P < 0.001); lower mean numbers of SICU days (4.5 days vs 1.2 days; P < 0.001) and telemetry days (12.7 days vs 9.7 days; P < 0.001); and lower rates of atrial arrhythmia (27% vs 19%; P = 0.013) and pulmonary complications (27% vs 20%; P = 0.016). Multivariable analysis revealed FTEP to be associated with shorter LOS (P < 0.001) even after adjustment for predictors like tumor histology and location. FTEP was also associated with a lower rate of pulmonary complications (odds ratio = 0.655; 95% confidence interval = 0.456, 0.942; P = 0.022). In addition, the median hospital charges associated with primary admission and readmission within 90 days for group B ($65,649) were lower than that for group A ($79,117; P < 0.001).
  
  
  CONCLUSIONS
  These findings suggest that an FTEP reduces patients' LOS, perioperative morbidity, and hospital charges.
authors.affiliation: *Department of Thoracic and Cardiovascular Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX †Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; and ‡Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jitesh B
authors.initials: JB
authors.lastname: Shewale
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Carla M
authors.initials: CM
authors.lastname: Baker
authors.forename: Nicole
authors.initials: N
authors.lastname: Villafane-Ferriol
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Victoria S
authors.initials: VS
authors.lastname: Jordan
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Katie M
authors.initials: KM
authors.lastname: Lewis
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Summers
authors.forename: Diane
authors.initials: D
authors.lastname: Schaub
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Wilks
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002985:Clinical Protocols; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D061214:Patient Safety / Q000191:economics / Q000592:standards; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D013686:Telemetry; D016896:Treatment Outcome; D055815:Young Adult