The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection

Area of Science:

• Surgical outcomes
• Gastrointestinal surgery
• Enhanced recovery protocols

Background:

• Enhanced recovery programmes (EROS) show promise in improving surgical outcomes.
• Implementation of EROS after upper gastrointestinal resection remains limited.
• This study aimed to evaluate short-term outcomes of EROS in oesophagogastric surgery.

Purpose of the Study:

• To assess the feasibility and safety of an Enhanced Recovery Programme (EROS) for patients undergoing major upper gastrointestinal resection.
• To compare short-term outcomes in patients managed within the EROS framework.
• To identify predictors of compliance with the EROS discharge target.

Main Methods:

• Development of the EROS protocol through multidisciplinary collaboration and iterative revisions.
• Application of EROS to all patients undergoing major upper GI resection at a UK university teaching hospital between September 2013 and September 2015.
• Assessment of EROS compliance and identification of factors associated with achieving the target discharge day.

Main Results:

• The study included 106 patients (81 oesophagectomies, 24 gastrectomies, 1 colonic interposition).
• Major complications (Clavien Dindo ≥3) occurred in 12 patients, with one in-hospital death.
• Forty-four percent (35/106) of patients were discharged on the target day (day 8); age and complications were independently associated with missing this target.

Conclusions:

• Enhanced recovery programmes are feasible and safe following major upper gastrointestinal surgery.
• The EROS protocol can be successfully implemented in a UK university teaching hospital setting.
• Further research may focus on optimizing EROS to improve discharge rates and reduce variability.