Abstract
Background
ERAS guidelines have provided an effective recovery approach for esophagectomy. This study aimed to identify the relationship between the length of hospital stay (LOS) and compliance with clinical benchmarks of an established institutional ERAS program.
Methods
A single-center prospective database of esophageal cancer patients was retrospectively analyzed between January 2016 and January 2020. All patients underwent surgery within a standardized ERAS pathway for esophagectomy. Compliance with individual ERAS benchmarks and postoperative outcomes were evaluated according to patient’s LOS; accelerated (≤ 6 days, AR), targeted (7–8 days, TR), and delayed recovery (≥ 9 days, DR).
Results
The study included 100 consecutive patients undergoing esophagectomy with a median LOS of 7 (3.8–40.8) days, and a 30-day readmission rate of 12.6%. LOS was not affected by comorbidities, tumor type or stage, neoadjuvant therapy, operative approach or anastomotic leak. Postoperative complications were 49.5%, and 90-day mortality was 3.8%. AR, TR, and DL were achieved by 45%, 31%, and 24% of patients, respectively. Postoperative morbidity differed significantly among groups, impacting LOS (p < 0.001). Overall compliance with ERAS protocol was 82.7% and adherence to specific benchmarks was initially (< 48 h) high, but significantly affected by postoperative complications afterwards.
Conclusions
Adherence to recovery benchmarks in patients undergoing esophagectomy is most commonly impacted by postoperative complications. In esophageal cancer surgery, the adherence to ERAS benchmarks after esophagectomy should be regularly audited. Modification to ERAS protocols to increase application in patients with complications should be considered.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00268-022-06722-7/MediaObjects/268_2022_6722_Fig1_HTML.png)
Similar content being viewed by others
References
Delaney CP, Fazio VW, Senagore AJ et al (2001) “Fast track” postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 88:1533–1538
Mortensen K, Nilsson M, Slim K et al (2014) Consensus guidelines for enhanced recovery after gastrectomy: enhanced recovery after surgery (ERAS(R)) society recommendations. Br J Surg 101:1209–1229
Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298
Low DE, Kunz S, Schembre D et al (2007) Esophagectomy—it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg 11:1395–1402 (discussion 1402)
Markar SR, Schmidt H, Kunz S et al (2014) Evolution of standardized clinical pathways: refining multidisciplinary care and process to improve outcomes of the surgical treatment of esophageal cancer. J Gastrointest Surg 18:1238–1246
Puccetti F, Kuppusamy MK, Hubka M et al (2020) Early distribution, clinical benefits, and limits of the implementation of the standardized clinical pathway following esophagectomy. Ann Esophagus. https://doi.org/10.21037/aoe.2020.02.06
Moorthy K, Halliday L (2022) Guide to enhanced recovery for cancer patients undergoing surgery: ERAS and oesophagectomy. Ann Surg Oncol 29:224–228
Low DE, Alderson D, Cecconello I et al (2015) International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy complications consensus group (ECCG). Ann Surg 262:286–294
Low DE, Allum W, De Manzoni G et al (2019) Guidelines for perioperative care in esophagectomy: enhanced recovery after surgery (ERAS((R))) society recommendations. World J Surg 43:299–330
Parise P, Ferrari C, Cossu A et al (2019) Enhanced recovery after surgery (ERAS) pathway in esophagectomy: is a reasonable prediction of hospital stay possible? Ann Surg 270:77–83
Elias KM, Stone AB, McGinigle K et al (2019) The reporting on ERAS compliance, outcomes, and elements research (RECOvER) checklist: a joint statement by the ERAS((R)) and ERAS((R)) USA societies. World J Surg 43:1–8
Schmidt HM, El Lakis MA, Markar SR et al (2016) Accelerated recovery within standardized recovery pathways after esophagectomy: a prospective cohort study assessing the effects of early discharge on outcomes, readmissions, patient satisfaction, and costs. Ann Thorac Surg 102:931–939
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
van der Werf LR, Busweiler LAD, van Sandick JW et al (2020) Reporting national outcomes after esophagectomy and gastrectomy according to the Esophageal Complications Consensus Group (ECCG). Ann Surg 271:1095–1101
Low DE, Kuppusamy MK, Alderson D et al (2019) Benchmarking complications associated with esophagectomy. Ann Surg 269:291–298
Kingma BF, Grimminger PP, van der Sluis PC et al (2020) Worldwide techniques and outcomes in robot-assisted minimally invasive esophagectomy (RAMIE): results from the multicenter international registry. Ann Surg. https://doi.org/10.1097/SLA.0000000000004550
Markar SR, Naik R, Malietzis G et al (2017) Component analysis of enhanced recovery pathways for esophagectomy. Dis Esophagus 30:1–10
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Puccetti, F., Klevebro, F., Kuppusamy, M. et al. Analysis of Compliance with Enhanced Recovery After Surgery (ERAS) Protocol for Esophagectomy. World J Surg 46, 2839–2847 (2022). https://doi.org/10.1007/s00268-022-06722-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-022-06722-7