Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy

• Published in: British journal of surgery Vol. 97; no. 5; pp. 714 - 718
• Main Authors: Munitiz, V., Martinez-de-Haro, L. F., Ortiz, A., Ruiz-de-Angulo, D., Pastor, P., Parrilla, P.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-05-2010; Wiley
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Critical Pathways - standards; Esophageal Neoplasms - surgery; Esophagectomy - methods; Feasibility Studies; Female; General aspects; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Postoperative Care - methods; Treatment Outcome; Young Adult; Medicine; Blood group; Treatment; Efficiency; Surgery; Written communication; Recovery
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.6942

Background:
This study assessed the feasibility of a protocol‐driven written clinical pathway for multidisciplinary postoperative management after oesophagectomy for oesophageal neoplasia, and examined whether the application of such a protocol could shorten hospital stay and reduce postoperative morbidity and mortality.
Methods:
Consecutive patients undergoing transthoracic oesophagectomy for oesophageal neoplasia were divided into those treated between 2003 and 2008 to whom a clinical pathway was applied for postoperative management (group 1), and a control group treated between 1998 and 2002 when no clinical pathway was applied (group 2).
Results:
There were 74 patients in each group. Morbidity rates were similar in the two groups: 31 per cent in group 1 and 38 per cent in group 2. There were more pulmonary complications in group 2 (23 versus 14 per cent; P = 0·025). One patient (1 per cent) in group 1 and four (5 per cent) in group 2 died after surgery (P = 0·010). The median (range) length of hospital stay was 9 (5–98) days for group 1 and 13 (8–106) days in group 2 (P = 0·012).
Conclusion:
Use of a written clinical pathway in patients undergoing oesophageal resection significantly reduced pulmonary complications, postoperative mortality and hospital stay. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Written protocols reduce complications