Implementation of an Early Feeding Pathway in Patients Undergoing Esophagectomy

Recent literature indicates that early oral feeding after esophagectomy is feasible and safe, though there is no standardized consensus for this nutritional advancement. The purpose of this study was to evaluate a standardized early feeding (EF) pathway implemented at a single quaternary institution.

All patients who underwent esophagectomy from January 2016 to September 2021 were evaluated. A standardized, prospective EF pathway was implemented at our institution beginning in January 2019 for all patients undergoing esophagectomy, while patients who had their esophagectomy prior to 2019 were considered "control patients." The "pathway cohort" was further categorized as either "pathway" or "no pathway" based on whether or not they completed the EF pathway. Patients were evaluated for index procedure length of stay, jejunostomy -tube and nasogastric tube duration, as well as 30-d and 90-d complications and readmission.

Fifty-seven patients entered into the EF pathway and 35 (61%) completed it. Pathway patients had a significantly reduced duration of NG tube (2 d versus 6 d, P=<0.001) as well as a significantly reduced length of stay (8 d versus 9 d, P = 0.003), compared to the control group, respectively. Pathway patients had significantly fewer in hospital grade 3 or 4 complications than those who did not complete the pathway and the controls (17% versus 41%, P = 0.05 and 45% P = 0.006, respectively).

Successful completion of an EF pathway significantly reduced hospital stay and nasogastric tube duration. Results of this study can be used as the basis for nationally standardizing EF after esophagectomy.