title: Standardized clinical pathways for esophagectomy are not a reality in Brazil, even with a high prevalence of esophageal cancer and achalasia.
abstract: BACKGROUND
  The adoption of standardized protocols and specialized multidisciplinary teams for esophagectomy involve changes in routines with the implantation of expensive clinical practices and deviations from ingrained treatment philosophies.
  
  
  OBJECTIVE
  To evaluate the prevalence of standardized protocols and specialized multidisciplinary teams in São Paulo state, Brazil.
  
  
  METHODS
  Institutions that routinely perform esophagectomies in São Paulo were contacted and questioned about the work team involved in the procedure and the presence of standardized routines in the preoperatory care.
  
  
  RESULTS
  Fifteen centers answered the questionnaire: 10 (67%) public institutions and five (33%) private. There were seven (47%) medical schools, six (40%) with a residency program and two (13%) nonacademic institutions. The mean number of esophagectomies per year was 23. There was a multidisciplinary pre-operative team in nine (60%). There was a multidisciplinary postoperative team in 11 (73%). Early mobilization protocol was adopted in 12 (80%) institutions, early feeding in 13 (87%), routinely epidural in seven (47%), analgesia protocol in seven (47%), hydric restriction in six (40%), early extubation in six (40%), standardized hospitalization time in four (27%) and standardized intensive care time in two (13%).
  
  
  CONCLUSIONS
  The prevalence of standardized protocols and specialized teams is very low in Sao Paulo state, Brazil. The presence of specialized surgeons is a reality and standardized protocols related directly to surgeons have higher frequency than those related to other professionals in the multidisciplinary team.
authors.affiliation: Department of Surgery, University of Campinas, Campinas, SP, Brazil.
authors.forename: Marina
authors.initials: M
authors.lastname: Zamuner
authors.affiliation: Department of Surgery, School of Medicine, Federal University of São Paulo, São Paulo, SP, Brasil.
authors.forename: Fernando A M
authors.initials: FA
authors.lastname: Herbella
authors.affiliation: Department of Surgery, University of Campinas, Campinas, SP, Brazil.
authors.forename: José L B
authors.initials: JL
authors.lastname: Aquino
mesh_terms: D001938:Brazil / Q000453:epidemiology; D019091:Critical Pathways / Q000592:standards*; D004931:Esophageal Achalasia / Q000453:epidemiology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D016629:Esophagectomy / Q000706:statistics & numerical data*; D006801:Humans; D015995:Prevalence; D011795:Surveys and Questionnaires