TY - JOUR

T1 - Impact of a Fast-track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges

AU - Shewale, Jitesh B

AU - Correa, Arlene M

AU - Baker, Carla M

AU - Villafane-Ferriol, Nicole

AU - Hofstetter, Wayne L

AU - Jordan, Victoria S

AU - Kehlet, Henrik

AU - Lewis, Katie M

AU - Mehran, Reza J

AU - Summers, Barbara L

AU - Schaub, Diane

AU - Wilks, Sonia A

AU - Swisher, Stephen G

AU - University of Texas MD Anderson Esophageal Cancer Collaborative Group

PY - 2015/6

Y1 - 2015/6

N2 - OBJECTIVE: To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges.BACKGROUND: FTEP involved transferring patients to the telemetry unit instead of the surgical intensive care unit (SICU) after esophagectomy.METHODS: 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.RESULTS: Compared with group A, group B had significantly shorter median LOS (12 days vs 8 days; P < 0.001); lower mean numbers of SICU days (4.5 days vs 1.2 days; P < 0.001) and telemetry days (12.7 days vs 9.7 days; P < 0.001); and lower rates of atrial arrhythmia (27% vs 19%; P = 0.013) and pulmonary complications (27% vs 20%; P = 0.016). Multivariable analysis revealed FTEP to be associated with shorter LOS (P < 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; P = 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; P < 0.001).CONCLUSIONS: These findings suggest that an FTEP reduces patients' LOS, perioperative morbidity, and hospital charges.

AB - OBJECTIVE: To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges.BACKGROUND: FTEP involved transferring patients to the telemetry unit instead of the surgical intensive care unit (SICU) after esophagectomy.METHODS: 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.RESULTS: Compared with group A, group B had significantly shorter median LOS (12 days vs 8 days; P < 0.001); lower mean numbers of SICU days (4.5 days vs 1.2 days; P < 0.001) and telemetry days (12.7 days vs 9.7 days; P < 0.001); and lower rates of atrial arrhythmia (27% vs 19%; P = 0.013) and pulmonary complications (27% vs 20%; P = 0.016). Multivariable analysis revealed FTEP to be associated with shorter LOS (P < 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; P = 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; P < 0.001).CONCLUSIONS: These findings suggest that an FTEP reduces patients' LOS, perioperative morbidity, and hospital charges.

U2 - 10.1097/SLA.0000000000000971

DO - 10.1097/SLA.0000000000000971

M3 - Journal article

C2 - 25243545

VL - 261

SP - 1114

EP - 1123

JO - Advances in Surgery

JF - Advances in Surgery

SN - 0003-4932

IS - 6

ER -