Component analysis of enhanced recovery pathways for esophagectomy
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
The objective of this systematic review is to identify key components of enhanced recovery protocols (ERP) that lead to improved length of hospital stay (LOS) following esophagectomy. Relevant electronic databases were searched for studies comparing clinical outcome from esophagectomy followed by a conventional pathway versus ERP. Relevant outcome measures were compared and metaregression was performed to identify the key ERP components associated with reduced in LOS. Thirteen publications were included, ERP was associated with no changes in in-hospital mortality, total complications, anastomotic leak, or pulmonary complications compared with a conventional pathway, however LOS was reduced in the ERP group. Metaregression identified that immediate extubation was associated with reduced LOS (OR = −0.51, 95%CI −0.77 to −0.25; P < 0.01). Several postoperative factors were associated with a significant reduction in length of hospital stay, and in order of most important were (i) gastrograffin swallow ≤5 days (OR = −4.27, 95%CI −4.50 to −4.03); (ii) mobilization on postoperative day ≤1 (OR = −2.49, 95%CI −2.63 to −2.34); (iii) removal of urinary catheter ≤2 days (OR = −0.99, 95%CI −1.15 to −0.84); (iv) oral intake with at least sips of fluid ≤1 day (OR = −0.96, 95%CI −1.24 to −0.68); (v) enteral diet with feeding jejunostomy or gastrostomy ≤ 1 day (OR = −0.57, 95%CI −0.80 to −0.35) and (vi) epidural removal ≤ 4 days (OR = −0.17, 95%CI −0.27 to −0.07). Several core ERP components and principles appear to be associated with LOS reduction. These elements should form a part of the core ERP for the specialty, while surgical teams incorporate other elements through an iterative process.
Date Issued
2017-10-01
Date Acceptance
2017-06-13
Citation
Diseases of the Esophagus, 2017, 30 (10)
ISSN
1120-8694
Publisher
Oxford University Press (OUP)
Journal / Book Title
Diseases of the Esophagus
Volume
30
Issue
10
Copyright Statement
This is a pre-copyedited, author-produced PDF of an article accepted for publication in Diseases of the Esophagus following peer review. The version of record S. R. Markar, R. Naik, G. Malietzis, L. Halliday, T. Athanasiou, K. Moorthy; Component analysis of enhanced recovery pathways for esophagectomy, Diseases of the Esophagus, Volume 30, Issue 10, 1 October 2017, Pages 1–10 is available online at: https://dx.doi.org/10.1093/dote/dox090
Subjects
Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
esophageal cancer
esophageal cancer surgery
supportive care
PROSPECTIVE COHORT
CLINICAL PATHWAY
OUTCOMES
CANCER
SURGERY
PROTOCOL
IMPACT
IMPLEMENTATION
METAANALYSIS
GASTRECTOMY
Publication Status
Published