Esophagectomy Enhanced Recovery After Surgery Initiative Results in Improved Outcomes
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Esophagectomy for esophageal cancer is a procedure with high morbidity and mortality. This study developed a Multidisciplinary Esophagectomy Enhanced Recovery Initiative (MERIT) pathway and analyzed implementation outcomes in a single institution.
METHODS: The MERIT pathway was developed as a practice optimization and quality improvement initiative. Patients were studied from November 1, 2021 to June 20, 2022 and were compared with historical control subjects. The Wilcoxon rank sum test and the Fisher exact test were used for statistical analysis.
RESULTS: The study compared 238 historical patients (January 17, 2017 to December 30, 2020) with 58 consecutive MERIT patients. There were no significant differences between patient characteristics in the 2 groups. In the MERIT group, 49 (85%) of the patients were male, and their mean age was 65 years (range, 59-71 years). Most cases were performed for esophageal cancer after neoadjuvant therapy. Length of stay improved by 27% from 11 to 8 days (P = .27). There was a 12% (P = .05) atrial arrhythmia rate reduction, as well as a 9% (P = .01) decrease in postoperative ileus. Overall complications were reduced from 54% to 35% (-19%; P = .01).
CONCLUSIONS: This study successfully developed and implemented an enhanced recovery after surgery pathway for esophagectomy. In the first year, study investigators were able to reduce overall complications, specifically atrial arrhythmias, and postoperative ileus.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:117 |
|---|---|
| Enthalten in: |
The Annals of thoracic surgery - 117(2024), 4 vom: 25. März, Seite 847-857 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Sims, Charles R [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 25.03.2024 Date Revised 25.03.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.athoracsur.2023.10.032 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM36534835X |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM36534835X | ||
| 003 | DE-627 | ||
| 005 | 20240325234446.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.athoracsur.2023.10.032 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1346.xml |
| 035 | |a (DE-627)NLM36534835X | ||
| 035 | |a (NLM)38043851 | ||
| 035 | |a (PII)S0003-4975(23)01220-1 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Sims, Charles R |c 3rd |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Esophagectomy Enhanced Recovery After Surgery Initiative Results in Improved Outcomes |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 25.03.2024 | ||
| 500 | |a Date Revised 25.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Esophagectomy for esophageal cancer is a procedure with high morbidity and mortality. This study developed a Multidisciplinary Esophagectomy Enhanced Recovery Initiative (MERIT) pathway and analyzed implementation outcomes in a single institution | ||
| 520 | |a METHODS: The MERIT pathway was developed as a practice optimization and quality improvement initiative. Patients were studied from November 1, 2021 to June 20, 2022 and were compared with historical control subjects. The Wilcoxon rank sum test and the Fisher exact test were used for statistical analysis | ||
| 520 | |a RESULTS: The study compared 238 historical patients (January 17, 2017 to December 30, 2020) with 58 consecutive MERIT patients. There were no significant differences between patient characteristics in the 2 groups. In the MERIT group, 49 (85%) of the patients were male, and their mean age was 65 years (range, 59-71 years). Most cases were performed for esophageal cancer after neoadjuvant therapy. Length of stay improved by 27% from 11 to 8 days (P = .27). There was a 12% (P = .05) atrial arrhythmia rate reduction, as well as a 9% (P = .01) decrease in postoperative ileus. Overall complications were reduced from 54% to 35% (-19%; P = .01) | ||
| 520 | |a CONCLUSIONS: This study successfully developed and implemented an enhanced recovery after surgery pathway for esophagectomy. In the first year, study investigators were able to reduce overall complications, specifically atrial arrhythmias, and postoperative ileus | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Abou Chaar, Mohamad K |e verfasserin |4 aut | |
| 700 | 1 | |a Kerfeld, Mitchell H |e verfasserin |4 aut | |
| 700 | 1 | |a Cassivi, Stephen D |e verfasserin |4 aut | |
| 700 | 1 | |a Hofer, Ryan E |e verfasserin |4 aut | |
| 700 | 1 | |a Nichols, Francis C |e verfasserin |4 aut | |
| 700 | 1 | |a Reisenauer, Janani |e verfasserin |4 aut | |
| 700 | 1 | |a Saddoughi, Sahar S |e verfasserin |4 aut | |
| 700 | 1 | |a Shen, K Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Stewart, Thomas M |e verfasserin |4 aut | |
| 700 | 1 | |a Tapias, Luis F |e verfasserin |4 aut | |
| 700 | 1 | |a Wigle, Dennis A |e verfasserin |4 aut | |
| 700 | 1 | |a Blackmon, Shanda H |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Annals of thoracic surgery |d 1965 |g 117(2024), 4 vom: 25. März, Seite 847-857 |w (DE-627)NLM000026689 |x 1552-6259 |7 nnns |
| 773 | 1 | 8 | |g volume:117 |g year:2024 |g number:4 |g day:25 |g month:03 |g pages:847-857 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.athoracsur.2023.10.032 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 117 |j 2024 |e 4 |b 25 |c 03 |h 847-857 | ||