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Enhanced Recovery After Surgery (ERAS) Pathway in Esophagectomy

Is a Reasonable Prediction of Hospital Stay Possible?

Parise, Paolo, MD*; Ferrari, Carlo, MD*; Cossu, Andrea, MD*; Puccetti, Francesco, MD*; Elmore, Ugo, MD, PhD*; De Pascale, Stefano, MD; Garutti, Leonardo, MD*; Fumagalli, Uberto Romario, MD; Di Serio, Mariaclelia Stefania, PhD; Rosati, Riccardo, MD, PhD, FACS§

doi: 10.1097/SLA.0000000000002775

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.

*Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy

Upper Gastrointestinal Surgery Unit, 2 General Surgery Unit, ASST Spedali Civili, Brescia, Italy

Vita-Salute San Raffaele University, Milan, Italy

§Department of Gastrointestinal Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.

Reprints: Carlo Ferrari, MD, via Olgettina 60, 20132 Milan, Italy. E-mail:

The authors report no conflicts of interest.

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