<50 3269 (70.79%) First operator, n (%) Specialist 2589 (56.06%) Resident 2029 (43.94%) Median operative time, min (IQR) 55 (40-70) Technique, n (%) Clipping 2841 (61.64%) Suturing/ligature 453 (9.79%) Stapler 313 (6.75%) Endoloop 606 (13.11%) Röder loop 403 (8.71%) Complicated appendicitis, n (%) 1269 (27.48%) Uncomplicated appendicitis, n (%) 3349 (72.52%) Intraoperative adverse events, n (%) 104 (2.25%) Drainage, n (%) 3493 (75.64%) Postoperative morbidity, n (%) 310 (6.71%) Clavien-Dindo classification of surgical complications, n (%) I 146 (3.16%) II 80 (1.73%) III 77 (1.67%) IV 4 (0.09%) V 3 (0.06%) Conversions, n (%) 294 (6.37%) Reinterventions after primary procedure, n (%) 98 (2.12%) LOS 3 (2-4) Readmissions, n (%) 118 (2.56%)
A perioperative treatment protocol, enhanced recovery after surgery (ERAS) focuses on accelerating patient recovery. Previous studies confirmed that ERAS decreases surgical trauma and the stress response, which improved outcomes including reduced length of hospital stay (LOS) and decreased postoperative morbidity. While ERAS protocols have been successfully implemented in a variety of surgical disciplines (colorectal, bariatric, orthopedic, and gynecologic surgery), its use in esophageal surgery is still limited. This paper analyzes the feasibility and value of the ERAS protocol for esophageal surgery. Reviewing the literature found that implementation of ERAS resulted in decreased costs, length of stay and pulmonary specific complication reduction, but not overall morbidity. The evidence lacks randomized control trials. Further, the ERAS Society published recommendations for esophageal resection. This opportunity for unification of the protocol would make the studies more comparable and leads to stronger conclusions. Surgery specific items also require further confirmation. Nonetheless, the successful introduction of the ERAS protocol into a wide variety of surgical disciplines provides optimism for ERAS's effectiveness in esophageal surgery.
Although still suboptimal, the situation is improving over time, with both trial registration and declaration of registration details more likely in later years.
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