Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy

Munítiz, Vicente; Martinez-de-Haro, L F; Ortiz, A. S.; Ruiz-de-Angulo, D; Pastor, Patricia; Parrilla, Pascual

doi:10.1002/bjs.6942

Cited by 108 publications

(70 citation statements)

References 16 publications

(19 reference statements)

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“…The results of this study showed that the postoperative thoracic drainage time and hospital stay of the observation group were significantly shorter than those of the control group, similar to the results of Preston et al and Munitiz et al (13,14). In addition, the incidence of pulmonary infections and anastomotic leakage, and the frequency of sputum suctioning, were lower than in the control group.…”

Section: Discussionsupporting

confidence: 89%

Feasibility and outcomes of modified enhanced recovery after surgery for nursing management of aged patients undergoing esophagectomy

Li¹,

Zheng²,

Zhang³

et al. 2017

J. Thorac. Dis.

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Background: The aim of this study was to determine whether a modified enhanced recovery after surgery (mERAS) protocol has a positive effect on the recovery of aged patients with esophageal cancer undergoing esophagectomy. Methods: Consecutive patients were selected between January 2015 and June 2016 and were randomly assigned to a control group (traditional nursing care) or an observation group (mERAS protocol). We analyzed the outcomes of the patients, including surgical outcomes, postoperative complications, mental health status, and quality of life (QOL). Results: Altogether, 110 patients who were >60 years of age were included in the study. They were evenly divided into two groups, with 55 patients in each. For the observation group, the thoracic drainage time was 1.07±0.26 days, first jejunal feeding time was at 11.71±1.81 h, time of first postoperative flatus was at 12.00±1.75 h, and length of postoperative stay was 8.31±1.25 days. There was no anastomotic leakage in the observation group, and the incidence of postoperative pulmonary infection was 5.45%. All the above indexes in the observation group were better than those for the patients receiving traditional nursing care. In addition, patients in the observation group had a lower level of mental suffering (P<0.05) and higher QOL (P<0.05). Conclusions: mERAS protocols could result in better postoperative recovery and reduce postoperative complications in aged patients undergoing esophagectomy. Hence, mERAS protocols could be useful in reducing patients' mental suffering and improving their QOL.

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Section: Discussionsupporting

confidence: 89%

Feasibility and outcomes of modified enhanced recovery after surgery for nursing management of aged patients undergoing esophagectomy

Li¹,

Zheng²,

Zhang³

et al. 2017

J. Thorac. Dis.

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“…There were 11 articles (1,128 patients) on fast track oesophageal surgery [11][12][13][14][15][16][17][18][19][20][21] and 7 (329 patients) on fast track gastric surgery. 12,[22][23][24][25][26][27] Ten articles were case series, five were case-controlled studies and three were RCTs (all gastrectomy related with a Jadad score of 1 or 2).…”

Section: Resultsmentioning

confidence: 99%

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Gemmill

Humes

Catton

2015

annals

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INTRODUCTION Fast track methodology or enhanced recovery schemes have gained increasing popularity in perioperative care. While evidence is strong for colorectal surgery, its importance in gastric and oesophageal surgery has yet to be established. This article reviews the evidence of enhanced recovery schemes on outcome for this type of surgery. METHODS A systematic literature search was conducted up to March 2014. Studies were retrieved and analysed using predetermined criteria. RESULTS From 34 articles reviewed, 18 eligible studies were identified: 7 on gastric and 11 on oesophageal resection. Three randomised controlled trials, five case-controlled studies and ten case series were identified. The reported protocols included changes to each stage of the patient journey from pre to postoperative care. The specific focus following oesophageal resections was on early mobilisation, a reduction in intensive care unit stay, early drain removal and early (or no) contrast swallow studies. Following gastric resections, the emphasis was on reducing epidural anaesthesia along with re-establishing oral intake in the first three postoperative days and early removal of nasogastric tubes. In the papers reviewed, mortality rates following fast track surgery were 0.8% (9/1,075) for oesophageal resection and 0% (0/329) for gastric resection. The reported morbidity rate was 16.5% (54/329) following gastric resection and 38.6% (396/1,075) following oesophageal resection. Length of stay was reduced in both groups compared with conventional recovery groups in comparative studies. CONCLUSIONS The evidence for enhanced recovery schemes following gastric and oesophageal resection is weak, with only three (low volume) published randomised controlled trials. However, the enhanced recovery approach appears safe and may be associated with a reduction in length of stay.

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“…This was a multidisciplinary procedure, undertaken by the physician assistants, senior nurses, 'key' nurses and medical staff. [20][21][22][23][24][25][26][27] Instead of a traditional 'day-to-day-care' plan for the surgical ward, an 'hour-to-hour' care plan had to be developed, including the PACU and ICU care. It was important to identify potential barriers and facilitators in these settings, in order to tailor the implementation strategy.…”

Section: Development Of the Cpmentioning

confidence: 99%

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

Kolk

Boogaard

Becking-Verhaar

et al. 2017

Journal of Gastrointestinal Surgery

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Introduction Medical and nursing protocols in perioperative care for pancreaticoduodenectomy are mainly mono-disciplinary, limiting their integration and transparency in a continuous health care system. The aims of this study were to evaluate adherence to a multidisciplinary clinical pathway for all pancreaticoduodenectomy patients during their entire hospital stay and to determine if the use of this clinical pathway is associated with beneficial effects on clinical end points. Materials and Methods A prospective cohort study was conducted in 95 pancreaticoduodenectomy patients treated according to a clinical pathway, including a variance report, compared to a historical control group (n = 52) with a traditional treatment regime. Results Process evaluation of the clinical pathway group revealed that protocol adherence throughout all units was above 80%. Major complications according to Clavien-Dindo classification grade ≥3 decreased from 27 to 13%; p = 0.02. Hospital length of stay was significantly shorter in the clinical pathway group, median 10 days ], compared with the control group, median 13 days ; p = 0.02. Conclusion The use of a clinical pathway in pancreaticoduodenectomy patients was associated with high protocol adherence, improved outcome and shorter hospital length of stay. Variance report analysis and protocol adherence with a Prepare-ActReflect Cycle are essential in surveillance of outcome.

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Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy

Cited by 108 publications

References 16 publications

Feasibility and outcomes of modified enhanced recovery after surgery for nursing management of aged patients undergoing esophagectomy

Feasibility and outcomes of modified enhanced recovery after surgery for nursing management of aged patients undergoing esophagectomy

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

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