The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection

Abstract

BackgroundEnhanced recovery programmes improve outcomes in surgery, but their implementation after upper gastrointestinal resection has been limited. The aim of this study was to compare short-term outcomes for patients undergoing oesophagogastric surgery in an enhanced recovery programme (EROS).MethodsEROS was developed after a multidisciplinary meeting by multiple rounds of revision. EROS was applied to all patients undergoing major upper GI resection at a university teaching hospital in the UK from 20/9/13, with data reviewed at 18/09/15. EROS was assessed to identify predictors for compliance.ResultsOne hundred six patients underwent major upper GI resection including 81 oesophagectomies, 24 gastrectomies and 1 colonic interposition graft. Major complications (Clavien Dindo ≥3) occurred in 12 patients with 1 in-hospital death. Thirty-five patients (44%) were discharged on target day 8 of the EROS programme. Age and complications were independently associated with missing this discharge target.ConclusionEnhanced recovery is feasible and safe after major upper gastrointestinal surgery.Electronic supplementary materialThe online version of this article (doi:10.1007/s11605-017-3363-8) contains supplementary material, which is available to authorized users.

Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…However, some more contemporary systematic reviews have highlighted that non‐standardized approaches could be introduced safely and were likely associated with a reduction in length of stay [26]. Improvements in targeted discharge goals and length of stay have been documented in other single‐center reports [27, 28]. Other reports have suggested improvements in anastomotic leak rate, pulmonary complications and length of stay, but have not demonstrated an improvement in overall mortality or readmissions [29].…”

Oesophageal cancer: The effect of early nutrition support on clinical outcomes

“…All patients were assessed by a dietitian at the pre-operative assessment clinic, reviewed daily during post-operative hospital stay and reviewed post discharge at the multi-disciplinary clinic. Patients followed a published and validated enhanced recovery programme [19] with early oral feeding commenced and built up to a pur ee consistency diet by Day 5 post-operatively. In the postoperative phase individuals were prescribed 2 Â 125ml high protein oral nutritional supplements (ONS) as a first line in addition to oral diet.…”

Enhanced Recovery Pathways (Eras) Implementation in Minimally Invasive Esophagectomy; An Early Experience

“…Underwood et al, described major morbidity of 10% in comparison to 18% in the year preceding to adaptation of ERAS pathway. 22 No significant difference was found in overall mortality rate (2.5%) in both groups (p=1.00).…”