Closing the Audit Cycle: Improving Short Term Outcomes of Oesophagectomy in a Provincial Hospital

Abstract

A previously published study regarding the outcomes of oesophagectomy at a provincial hospital identified issues with perioperative care (Al-Herz et al 2012). The aim of this study was to evaluate the effect of changes in management at the institution concerned. This was a cohort study which compared the outcomes of 30 patients undergoing oesophagectomy before the unit audit and 30 patients after it. Demographics, operative details, recovery parameters, and oncological data were collected retrospectively. There was a significant reduction in the use of intravenous fluid, both intraoperatively (6.6 vs 3.3L, P < 0.0001) and during the first 24 hours (9.2 vs 5.5L, P < 0.0001). Patients were extubated three days earlier (P < 0.001) after the audit, and the percentage of patients requiring tracheostomy was smaller (26.7% vs 0%, P = 0.003). The length of total hospital stay was shorter (15 vs 13 days, P = 0.035). We conclude that the publication of a unit audit changed perioperative practice and resulted in a significant improvement in the short term outcomes after oesophagectomy.

Integrating perioperative medicine with anaesthesia in India: Can the best be achieved? A review

“…Elements of the ERAS pathways for different surgical subgroups are essentially the same with minor modifications. [1516171819202122232425262728293031323334353637383940414243444546474849] General elements include preoperative nutritional screening, no preoperative bowel preparation, maltodextrin drink 2 h before surgery, prophylactic antibiotics, epidural or patient-controlled analgesia, prokinetic agents, goal-directed fluid therapy, early mobilisation, predefined criteria for removal of drains, nasogastric tubes and catheters, immediate extubation, early oral intake and a specific discharge plan. Surgery-specific elements like octreotide for pancreaticoduodenectomies, minimal tissue handling and minimally invasive surgery for urogynaecological oncosurgery or pharmacological thromboprophylaxis for head and neck free-flap surgery are important.…”

“…Advantages of adherence to ERAS are reduced length of hospital stay (LOS), reduced median operative time and intraoperative blood loss, reduced morbidity and complications, lower delayed gastric emptying rates, decreased insulin resistance, reduced IV fluid requirement during and for 3 days after surgery and improved 5-year survival [Table 1]. [1819202122232425262728293031323334353637383940414243444546474849] American Society for Enhanced Recovery and Perioperative Quality Initiative has recently (2018) issued joint consensus statements on optimal analgesia, prevention of postoperative infection, patient-reported outcome and postoperative gastrointestinal dysfunction within an ERAS pathway for colorectal surgery which were hitherto grey areas of the ERAS protocol, ushering an era of evidence-based perioperative medicine. [53545556575859] Return to intended oncotherapy is another recent parameter and time to adjuvant chemotherapy post colorectal cancer surgery is associated with an improved survival rate.…”

Impact of Enhanced Recovery Protocols on Short‐Term Outcomes in Esophagectomy: A Retrospective Cohort Study from Cancer Research Institute, Uttarakhand, India

“…Various authors have described a reduction in mortality, categorical variables is calculated using ad/bc, therefore if any of a or d is 0-the odds ratio will be 0 and if any of b or c is 0-the odds ratio will be infinite. Therefore, for those scenarios, the odds ratio has been reported as can't calculate PP pre-protocol group, ERP enhanced recovery protocol group, p \ 0.05 considered statistically significant, FJ feeding jejunostomy complications and length of stay with a quicker return to work on the adoption of the ERAS protocols for these surgeries [13][14][15][16].…”

Oesophagectomy at a New Zealand regional centre: where to now?

“…Three hundred patients are diagnosed annually, and 270 will die within 24 months of diagnosis. 5,6 However, oesophagectomy has been poorly studied in New Zealand with the first publication recorded in 1961 7 followed by publications from Wellington, 8 Dunedin, 9 Palmerston North [10][11][12] and Christchurch, 13,14 and no designated regional or national referral centres exist. However, the procedure is associated with significant morbidity 3 and care of patients following oesophagectomy requires access to significant resources, including intensive care, interventional radiology and advanced endoscopy 4 and concentrating patients requiring oesophagectomy in single high-volume centres may lead to improved outcomes.…”

“…However, the procedure is associated with significant morbidity 3 and care of patients following oesophagectomy requires access to significant resources, including intensive care, interventional radiology and advanced endoscopy 4 and concentrating patients requiring oesophagectomy in single high-volume centres may lead to improved outcomes. 5,6 However, oesophagectomy has been poorly studied in New Zealand with the first publication recorded in 1961 7 followed by publications from Wellington, 8 Dunedin, 9 Palmerston North [10][11][12] and Christchurch, 13,14 and no designated regional or national referral centres exist.…”