title: Clinical pathway for esophagectomy improves perioperative nutrition.
abstract: BACKGROUND
  Clinical pathways reduce hospitalization and costs in colorectal and pancreatic cancer. We describe creating an esophagectomy pathway and analyze its implementation and effects.
  
  
  METHODS
  We documented the process of developing an esophagectomy clinical pathway. We performed a retrospective review of prospectively collected data on 12 patients before pathway implementation and 12 patients after.
  
  
  RESULTS
  Pathway Implementation: more patients were presented at tumor board (9 pathway vs. 2 pre-pathway; p=0.012) and chose their postoperative care facility before surgery (8 vs. 0; p=0.0013) OUTCOMES: There were no changes in mortality (0 vs. 0), major complications (5 vs. 5), hospitalization (median 9.5 vs. 12 days; p=0.82), and total charges ($ 98,395 vs. $ 96,946; p=0.96). Pathway patients lost significantly less weight preoperatively (2.3% vs. 7.6%; p=0.01) and perioperatively (6.3% vs. 12%; p=0.02).
  
  
  CONCLUSIONS
  This is the first study to report the process of designing and implementing an esophagectomy pathway. While there was no significant decrease in mortality, complications, hospitalization, or charges, our pathway significantly decreased pre- and perioperative weight loss, which we attribute to coordinated patient education and care.
authors.affiliation: Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States.
authors.forename: Vignesh
authors.initials: V
authors.lastname: Raman
authors.affiliation: Temple University School of Medicine, Temple University Health System, United States.
authors.forename: Larry R
authors.initials: LR
authors.lastname: Kaiser
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Temple University Health Systems, Parkinson Pavilion, Suite C-100, Philadelphia, PA 19140, United States. Electronic address: Cherie.P.Erkmen@tuhs.temple.edu.
authors.forename: Cherie P
authors.initials: CP
authors.lastname: Erkmen
mesh_terms: D000368:Aged; D019091:Critical Pathways; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D019990:Perioperative Care / Q000592:standards; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
keywords: Clinical pathway; Esophageal Cancer; Esophagectomy; Weight loss