Esophagectomy Enhanced Recovery After Surgery Initiative Results in Improved Outcomes

Area of Science:

• Surgery
• Gastroenterology
• Oncology

Background:

• Esophagectomy for esophageal cancer carries high risks.
• A Multidisciplinary Esophagectomy Enhanced Recovery Initiative (MERIT) pathway was developed to optimize care.
• This study evaluated the MERIT pathway's implementation outcomes at a single institution.

Purpose of the Study:

• To assess the effectiveness of the MERIT pathway in improving patient outcomes after esophagectomy.
• To analyze the impact of the enhanced recovery pathway on complication rates and hospital stay.
• To implement a quality improvement initiative for esophagectomy patients.

Main Methods:

• A retrospective study comparing 238 historical controls with 58 consecutive MERIT pathway patients.
• Statistical analysis using Wilcoxon rank sum test and Fisher exact test.
• Patient data collected from November 1, 2021, to June 20, 2022, compared to historical controls (January 17, 2017, to December 30, 2020).

Main Results:

• Length of stay decreased by 27% (11 to 8 days).
• Atrial arrhythmia rate reduced by 12% (P=.05).
• Postoperative ileus decreased by 9% (P=.01), and overall complications fell from 54% to 35% (P=.01).

Conclusions:

• The MERIT pathway was successfully developed and implemented for esophagectomy.
• The pathway led to significant reductions in overall complications, atrial arrhythmias, and postoperative ileus within the first year.
• This enhanced recovery after surgery pathway shows promise for improving esophagectomy patient care.