Impact of a Fast-track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Shewale, Jitesh B.; Correa, Arlene M.; Baker, Carla M.; Villafane-Ferriol, Nicole; Hofstetter, Wayne L.; Jordan, Victoria S.; Kehlet, Henrik; Lewis, Katie M.; Mehran, Reza J.; Summers, Barbara L.; Schaub, Diane; Wilks, Sonia A.; Swisher, Stephen G.
• Is Part Of: Annals of surgery. Volume 261:Issue 6(2015:Jun.)
• Publication Date: 2015-06
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000971
• Languages: English
• ISSNs: 0003-4932

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges.</p> </sec> <sec> <title>Background:</title> <p>FTEP involved transferring patients to the telemetry unit instead of the surgical intensive care unit (SICU) after esophagectomy.</p> </sec> <sec> <title>Methods:</title> <p>We retrospectively reviewed 708 consecutive patients who underwent esophagectomy for primary esophageal cancer during the 4 years before (group A; 322 patients) or 4 years after (group B; 386 patients) the institution of an FTEP. Postoperative morbidity and mortality, LOS, and hospital charges were reviewed.</p> </sec> <sec> <title>Results</title> <p>: Compared with group A, group B had significantly shorter median LOS (12 days vs 8 days; <italic>P</italic> < 0.001); lower mean numbers of SICU days (4.5 days vs 1.2 days; <italic>P</italic> < 0.001) and telemetry days (12.7 days vs 9.7 days; <italic>P</italic> < 0.001); and lower rates of atrial arrhythmia (27% vs 19%; <italic>P</italic> = 0.013) and pulmonary complications (27% vs 20%; <italic>P</italic> = 0.016). Multivariable analysis revealed FTEP to be associated with shorter LOS (<italic>P</italic> < 0.001) even after adjustment for predictors like tumor histology and location. FTEP was also associated with a lower rate of pulmonary complications (odds ratio = 0.655; 95% confidence interval = 0.456, 0.942; <italic>P</italic> = 0.022). In addition, the median hospital charges associated with primary admission and readmission within 90 days for group B ($65, 649) were lower than that for group A ($79, 117; <italic>P</italic> < 0.001).</p> </sec> <sec> <title>Conclusions:</title> <p>These findings suggest that an FTEP reduces patients' LOS, perioperative morbidity, and hospital charges.</p> </sec> </abstract>