Alisa N Blumenthaler1, Kristen A Robinson1, Brittany C Kruse2, Kathryn Munder3, Naruhiko Ikoma1, Paul F Mansfield1, Vijaya Gottumukkala2,4, Ravish Kapoor4, Brian D Badgwell1. 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 2. The Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 3. Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 4. Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Abstract
BACKGROUND AND OBJECTIVES: The purpose of this study was to compare surgical outcomes before and after implementation of an enhanced recovery protocol (ERP) in gastrectomy for gastric cancer. METHODS: We included patients who underwent open gastrectomy for gastric cancer before (January 2016 to September 2018) or after (October 2018 to September 2020) ERP implementation. The primary outcome was the postoperative length of stay (LOS). Secondary outcomes included 90-day readmission rates and Clavien-Dindo grade ≥ 3 complications. RESULTS: One hundred patients underwent gastrectomy before (pre-ERP group) and 52 underwent gastrectomy after (ERP group) protocol implementation. Demographic and clinicopathologic characteristics were similar. The median (interquartile range) postoperative LOS was shorter in the ERP group (7.0 days [6.0-8.0] vs. 8.0 days [7.0-11.0]; p < 0.001). The ERP group had similar rates of readmission (33% vs. 24%; p = 0.34) and grade ≥ 3 complications (19% vs. 19%; p = 1.0) compared to the pre-ERP group, but experienced lower rates of surgical wound complications (0% vs. 19%; p < 0.001). Rates of other complications were similar. CONCLUSIONS: Implementation of an ERP in patients undergoing open gastrectomy for gastric cancer is feasible and safe and has the potential to decrease postoperative LOS without increasing complication rates.
BACKGROUND AND OBJECTIVES: The purpose of this study was to compare surgical outcomes before and after implementation of an enhanced recovery protocol (ERP) in gastrectomy for gastric cancer. METHODS: We included patients who underwent open gastrectomy for gastric cancer before (January 2016 to September 2018) or after (October 2018 to September 2020) ERP implementation. The primary outcome was the postoperative length of stay (LOS). Secondary outcomes included 90-day readmission rates and Clavien-Dindo grade ≥ 3 complications. RESULTS: One hundred patients underwent gastrectomy before (pre-ERP group) and 52 underwent gastrectomy after (ERP group) protocol implementation. Demographic and clinicopathologic characteristics were similar. The median (interquartile range) postoperative LOS was shorter in the ERP group (7.0 days [6.0-8.0] vs. 8.0 days [7.0-11.0]; p < 0.001). The ERP group had similar rates of readmission (33% vs. 24%; p = 0.34) and grade ≥ 3 complications (19% vs. 19%; p = 1.0) compared to the pre-ERP group, but experienced lower rates of surgical wound complications (0% vs. 19%; p < 0.001). Rates of other complications were similar. CONCLUSIONS: Implementation of an ERP in patients undergoing open gastrectomy for gastric cancer is feasible and safe and has the potential to decrease postoperative LOS without increasing complication rates.
Authors: Bradford J Kim; Heather A Lillemoe; Timothy E Newhook; Whitney L Dewhurst; Elsa M Arvide; Matthew H G Katz; Thomas A Aloia; Jean-Nicolas Vauthey; Jeffrey E Lee; Ching-Wei D Tzeng Journal: J Surg Oncol Date: 2020-05-23 Impact factor: 3.454
Authors: K Mortensen; M Nilsson; K Slim; M Schäfer; C Mariette; M Braga; F Carli; N Demartines; S M Griffin; K Lassen Journal: Br J Surg Date: 2014-07-21 Impact factor: 6.939
Authors: Yuki Hirata; Russell G Witt; Laura R Prakash; Elsa M Arvide; Kristen A Robinson; Vijaya Gottumukkala; Ching-Wei D Tzeng; Paul Mansfield; Brian D Badgwell; Naruhiko Ikoma Journal: Ann Surg Oncol Date: 2022-05-04 Impact factor: 4.339