Enhanced Recovery After Surgery (ERAS) Pathway in Esophagectomy Is a Reasonable Prediction of Hospital Stay Possible?

被引:29
作者
Parise, Paolo [1 ]
Ferrari, Carlo [1 ]
Cossu, Andrea [1 ]
Puccetti, Francesco [1 ]
Elmore, Ugo [1 ]
De Pascale, Stefano [2 ]
Garutti, Leonardo [1 ]
Fumagalli, Uberto Romario [2 ]
Di Serio, Mariaclelia Stefania [3 ]
Rosati, Riccardo [4 ]
机构
[1] Osped San Raffaele, Dept Gastrointestinal Surg, Milan, Italy
[2] ASST Spedali Civili, 2 Gen Surg Unit, Upper Gastrointestinal Surg Unit, Brescia, Italy
[3] Univ Vita Salute San Raffaele, Milan, Italy
[4] Univ Vita Salute San Raffaele, San Raffaele Hosp, Dept Gastrointestinal Surg, Milan, Italy
关键词
enhanced recovery; ERAS pathways; esophageal cancer; esophagectomy; COLORECTAL SURGERY; CLINICAL PATHWAY; CANCER; OUTCOMES; MORTALITY; PROTOCOL; PROGRAM; COHORT;
D O I
10.1097/SLA.0000000000002775
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To assess whether perioperative variables or deviation from enhanced recovery after surgery (ERAS) items could be associated with delayed discharge after esophagectomy, and to convert them into a scoring system to predict it. Summary Background Data: ERAS perioperative pathways have been recently applied to esophageal resections. However, low adherence to ERAS items and high rates of protocol deviations are often reported. Methods: All patients who underwent esophagectomy between April 2012 and March 2017 were managed with a standardized perioperative pathway according to ERAS principles. The target length of stay was set at eighth postoperative day (POD). All significant variables at bivariate analysis were entered into a logistic regression to produce a predictive score. An initial validation of the score accuracy was carried out on a separate patient sample. Results: Two hundred eighty-six patients were included in the study. Multivariate regression analysis showed that American Society of Anesthesiology score >= 3, surgery duration > 255 min, "nonhybrid'' esophagectomy, and failure to mobilize patients within 24 h from surgery were associated with delayed discharge. The logistic regression model was statistically significant (P < 0.001) and correctly classified 81.9% of cases. The sensitivity was 96.6%, and the specificity was 17.6%. The prediction score applied to 23 patients correctly identified 100% of those discharged after eighth POD. Conclusions: The results of this study seem to be clinically meaningful and in linewith those fromother studies. The initial validation revealed good predictive properties.
引用
收藏
页码:77 / 83
页数:7
相关论文
共 32 条
[1]   Initial Experiences of an Enhanced Recovery Protocol in Esophageal Surgery [J].
Blom, Rachel L. G. M. ;
van Heijl, Mark ;
Bemelman, Willem A. ;
Hollmann, Markus W. ;
Klinkenbijl, Jean H. G. ;
Busch, Olivier R. C. ;
Henegouwen, Mark I. van Berge .
WORLD JOURNAL OF SURGERY, 2013, 37 (10) :2372-2378
[2]   Early outcome of thoracoscopic and hybrid esophagectomy: Propensity-matched comparative analysis [J].
Bonavina, Luigi ;
Scolari, Federica ;
Aiolfi, Alberto ;
Bonitta, Gianluca ;
Sironi, Andrea ;
Saino, Greta ;
Asti, Emanuele .
SURGERY, 2016, 159 (04) :1073-1081
[3]   Enhanced Recovery After Surgery Pathway in Patients Undergoing Pancreaticoduodenectomy [J].
Braga, Marco ;
Pecorelli, Nicol ;
Ariotti, Riccardo ;
Capretti, Giovanni ;
Greco, Massimiliano ;
Balzano, Gianpaolo ;
Castoldi, Renato ;
Beretta, Luigi .
WORLD JOURNAL OF SURGERY, 2014, 38 (11) :2960-2966
[4]   Purposeful selection of variables in logistic regression [J].
Bursac, Zoran ;
Gauss, C. Heath ;
Williams, David Keith ;
Hosmer, David W. .
SOURCE CODE FOR BIOLOGY AND MEDICINE, 2008, 3 (01)
[5]   Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study [J].
Cao, Shouqiang ;
Zhao, Guibin ;
Cui, Jian ;
Dong, Qing ;
Qi, Sihua ;
Xin, Yanzhong ;
Shen, Baozhong ;
Guo, Qingfeng .
SUPPORTIVE CARE IN CANCER, 2013, 21 (03) :707-714
[6]   Fast tracking after Ivor Lewis esophagogastrectomy [J].
Cerfolio, RJ ;
Bryant, AS ;
Bass, CS ;
Alexander, JR ;
Bartolucci, AA .
CHEST, 2004, 126 (04) :1187-1194
[7]   The Clavien-Dindo Classification of Surgical Complications Five-Year Experience [J].
Clavien, Pierre A. ;
Barkun, Jeffrey ;
de Oliveira, Michelle L. ;
Vauthey, Jean Nicolas ;
Dindo, Daniel ;
Schulick, Richard D. ;
de Santibanes, Eduardo ;
Pekolj, Juan ;
Slankamenac, Ksenija ;
Bassi, Claudio ;
Graf, Rolf ;
Vonlanthen, Rene ;
Padbury, Robert ;
Cameron, John L. ;
Makuuchi, Masatoshi .
ANNALS OF SURGERY, 2009, 250 (02) :187-196
[8]   The effect of formalizing enhanced recovery after esophagectomy with a protocol [J].
Findlay, J. M. ;
Tustian, E. ;
Millo, J. ;
Klucniks, A. ;
Sgromo, B. ;
Marshall, R. E. K. ;
Gillies, R. S. ;
Middleton, M. R. ;
Maynard, N. D. .
DISEASES OF THE ESOPHAGUS, 2015, 28 (06) :567-573
[9]   Enhanced Recovery for Esophagectomy A Systematic Review and Evidence-Based Guidelines [J].
Findlay, John M. ;
Gillies, Richard S. ;
Millo, Julian ;
Sgromo, Bruno ;
Marshall, Robert E. K. ;
Maynard, Nicholas D. .
ANNALS OF SURGERY, 2014, 259 (03) :413-431
[10]   Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery [J].
Gatenby, P. A. C. ;
Shaw, C. ;
Hine, C. ;
Scholtes, S. ;
Koutra, M. ;
Andrew, H. ;
Hacking, M. ;
Allum, W. H. .
ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, 2015, 97 (07) :502-507