title: Propensity Score Analysis of an Enhanced Recovery Programme in Upper Gastrointestinal Cancer Surgery.
abstract: BACKGROUND
  The aim of this study was to examine the influence of an enhanced recovery programme (ERP) on outcomes of upper gastrointestinal (UGI) cancer surgery by means of propensity score-matched analysis.
  
  
  METHODS
  Three hundred consecutive patients diagnosed with UGI cancer were studied prospectively before and after the introduction of an ERP. Multiple regression models, including propensity scores, were developed to assess confounding variables associated with undergoing surgery, and the risk adjusted association between treatment and length of hospital stay (LOHS).
  
  
  RESULTS
  After regression for confounding factors, a cohort of 252 patients was available of whom 160 received ERP [median age 66 years (IQR 58-73), 119 male, 81 oesophageal, 79 gastric cancer] and 92 control [66 years (IQR 58-74), 74 male, 58 oesophageal, 34 gastric cancer]. ERP operative morbidity (Clavien-Dindo ≥3) and mortality were 13.8 and 3.1 % compared with 17.4 (p = 0.449) and 2.2 % (p = 0.658) in controls. Median ERP critical care and total LOS were 1 (IQR 0-1) and 13 (IQR 10-17) days, compared with 1 (IQR 1-2, p = 0.009) and 16 (IQR 13-26, p < 0.001) days. Multivariable analysis revealed ERP (HR 1.477, 95 % CI 1.084-2.013, p = 0.013), tumour location (HR 2.420, 95 % CI 1.624-3.606, p < 0.001), operative procedure (HR 1.143, 95 % CI 1.032-1.265, p = 0.010), and operative morbidity (HR 0.277, 95 % CI 0.179-0.429, p < 0.001) to be associated with LOHS.
  
  
  CONCLUSIONS
  An ERP in UGI cancer surgery was feasible, safe, and effective.
authors.affiliation: Departments of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: A
authors.initials: A
authors.lastname: Karran
authors.affiliation: Departments of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wheat
authors.affiliation: Departments of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: D
authors.initials: D
authors.lastname: Chan
authors.affiliation: Departments of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: P
authors.initials: P
authors.lastname: Blake
authors.affiliation: Departments of Dietetics, University Hospital of Wales, Cardiff, CF14 4XW, UK.
authors.forename: R
authors.initials: R
authors.lastname: Barlow
authors.affiliation: Departments of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. wyn.lewis4@wales.nhs.uk.
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D057216:Propensity Score; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*