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Ann Surg. 2019 Jul;270(1):77-83. doi: 10.1097/SLA.0000000000002775.

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

Author information

1
Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy.
2
Upper Gastrointestinal Surgery Unit, 2 General Surgery Unit, ASST Spedali Civili, Brescia, Italy.
3
Vita-Salute San Raffaele University, Milan, Italy.
4
Department of Gastrointestinal Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.

Abstract

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 line with those from other studies. The initial validation revealed good predictive properties.

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