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ERAS 2.0: Continued Refinement of an Established Enhanced Recovery Protocol for Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We have previously demonstrated that implementing an enhanced recovery protocol (ERP) improved outcomes after esophagectomy. We sought to examine if, after a decade of an established ERP, further improvements in postoperative outcomes could be made after continually optimizing and revising the pathway.

Methods

Patients undergoing esophagectomy for cancer from January 2019 to January 2020 were compared with our early-experience group within the initial ERP (June 2010–May 2011) and pre-ERP traditional care (June 2009–May 2010). The original ERP was initiated on June 2010 and underwent several revisions from 2014 to 2018, incorporating the following, amongst other elements: shorten the planned length of stay from 7 to 6 days, elimination of nasogastric tubes, use of soft closed-suction chest drains, and increased application of minimally invasive esophagectomy (MIE). Thirty-day outcomes (complications, length of stay, readmission) were compared for patients undergoing esophagectomy during the initial and most recent ERPs.

Results

Overall, 175 patients were identified; 47 underwent esophagectomy before ERP implementation (traditional care), 59 patients underwent esophagectomy after implementation of the original ERP, and 69 patients underwent esophagectomy after the most recent ERP (ERP 2.0). The groups were similar with respect to age, sex, and diagnosis. There were three times more MIEs in the ERP 2.0 group with a shorter median length of stay (7 [6–9] vs. 8 [7–17] vs. 10 [9–17]; p < 0.001) without impacting postoperative morbidity or readmission rate.

Conclusion

Continued evaluation of institutional outcomes after esophagectomy should be performed to identify target areas for optimization and revision of established enhanced recovery protocols. ERPs are dynamic processes that can be further refined to yield greater improvements in outcomes.

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Funding

This study did not receive any funding.

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Authors and Affiliations

  1. Division of Thoracic Surgery, McGill University Health Centre, Montreal, QC, Canada

    Yehonatan Nevo MD, Amit Katz MD, Jonathan Spicer MD, PhD, Jonathan Cools-Lartigue MD, PhD, Carmen Mueller MD, MEd & Lorenzo Ferri MD, PhD

  2. Faculty of Medicine, The Royal College of Surgeons in Ireland, Dublin, Ireland

    Sarah Arjah BSc

  3. Division of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada

    Jose Luis Ramírez García Luna MD, MSc

  4. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

    Liane Feldman MD

Authors
  1. Yehonatan Nevo MD
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  2. Sarah Arjah BSc
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  3. Amit Katz MD
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  4. Jose Luis Ramírez García Luna MD, MSc
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  5. Jonathan Spicer MD, PhD
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  6. Jonathan Cools-Lartigue MD, PhD
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  7. Carmen Mueller MD, MEd
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  8. Liane Feldman MD
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  9. Lorenzo Ferri MD, PhD
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Corresponding author

Correspondence to Yehonatan Nevo MD.

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Disclosure

Yehonatan Nevo, Sarah Arjah, Amit Katz, Jose Ramirez Garcia Luna, Jonathan Spicer, Jonathan Cools-Lartigue, Carmen Muller, Liane Feldman, and Lorenzo Ferri have no conflicts of interest to declare.

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Nevo, Y., Arjah, S., Katz, A. et al. ERAS 2.0: Continued Refinement of an Established Enhanced Recovery Protocol for Esophagectomy. Ann Surg Oncol 28, 4850–4858 (2021). https://doi.org/10.1245/s10434-021-09854-7

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  • DOI: https://doi.org/10.1245/s10434-021-09854-7

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