The Kaiser Permanente Northern California Enhanced Recovery After Surgery Program: Design, Development, and Implementation

Liu, Vincent X; Rosas, Efrén Raúl Ponce; Hwang, Judith C.F.; Cain, Eric; Foss-Durant, Anne M.; Clopp, Molly P; Huang, Mengfei; Mustille, Alexander; Reyes, Vivian; Paulson, Shirley; Caughey, Michelle; Parodi, Stephen

doi:10.7812/tpp/17-003

Cited by 17 publications

(15 citation statements)

References 29 publications

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“…Postoperatively, the urinary catheter and nasogastric tube were removed on the first day and a clear-liquid diet started and early ambulation instituted. Detailed descriptions of all aspects of the KPNC ERAS protocols are provided elsewhere [ 49 , 50 ]. Most patients are discharged on postoperative day 3 (patients are eligible for discharge on day 3 if they have no leak on the esophagram, absence of tachycardia or fever, are able to sustain hydration and nutrition with over 2 L of fluid orally per day, their pain is adequately treated with oral medication, and they appear clinically well).…”

Section: Methodsmentioning

confidence: 99%

A refined procedure for esophageal resection using a full minimally invasive approach

Ashiku

Patel

Horton

et al. 2022

J Cardiothorac Surg

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Objective Newer minimally invasive approaches to esophagectomy have brought substantial benefits to esophageal-cancer patients and continue to improve. We report here our experience with a streamlined procedure as part of a comprehensive perioperative-care program that provides additional advances in the continued evolution of this procedure. Methods All patients with primary esophageal cancer referred for resection to the Oakland Medical Center of the Kaiser-Permanente Northern California health plan who underwent this approach between January 2013 and August 2018 were included. Operative and clinical outcome variables were extracted from the electronic medical record, operating-room files, and manual chart review. Results 142 patients underwent the new procedure and care program; 121 (85.2%) were men with mean age of 64.5 years. 127 (89.4%) were adenocarcinoma; 117 (82.4%) were clinical stage III or IVA. 115 (81.0%) required no jejunostomy. Median hospital length-of-stay was 3 days and 8 (5.6%) patients required admission to the intensive care unit. Postoperative complications occurred in 22 (15.5%) patients within 30 days of the procedure. There were no inpatient deaths; one patient (0.7%) died within 30 days following discharge and three additional deaths (2.1%) occurred through 90 days of follow-up. Conclusions This approach resulted in excellent clinical outcomes, including short hospital stays with limited need for the intensive care unit, few perioperative complications, and relatively few patients requiring feeding tubes on discharge. This comprehensive approach to esophagectomy is feasible and provides another clinically meaningful advance in the progress of minimally invasive esophagectomy. Further development and dissemination of this method is warranted.

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Section: Methodsmentioning

confidence: 99%

A refined procedure for esophageal resection using a full minimally invasive approach

Ashiku

Patel

Horton

et al. 2022

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Postoperatively, the urinary catheter and nasogastric tube were removed on the rst day and a clear-liquid diet started and early ambulation instituted. Detailed descriptions of all aspects of the KPNC ERAS protocols are provided elsewhere (49,50). Most patients are discharged on postoperative day 3 (patients are eligible for discharge on day 3 if they have no leak on the esophagram, absence of tachycardia or fever, are able to sustain hydration and nutrition with over 2 liters of uid orally per day, their pain is adequately treated with oral medication, and they appear clinically well).…”

Section: Page 3/16mentioning

confidence: 99%

A Refined Procedure for Esophageal Resection Using a Full Minimally Invasive Approach

Ashiku

et al. 2021

Preprint

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Objective: Newer minimally invasive approaches to esophagectomy have brought substantial benefits to esophageal-cancer patients and continue to improve. We report here our experience with a streamlined procedure as part of a comprehensive perioperative-care program that provides additional advances in the continued evolution of this procedure.Methods: All patients with primary esophageal cancer referred for resection to the Oakland Medical Center of the Kaiser-Permanente Northern California health plan who underwent this approach between January 2013 and August 2018 were included. Operative and clinical outcome variables were extracted from the electronic medical record, operating-room files, and manual chart review.Results: 142 patients underwent the new procedure and care program; 121 (85.2%) were men with mean age of 64.5 years. 127 (89.4%) were adenocarcinoma; 117 (82.4%) were clinical stage III or IVA. 115 (81.0%) required no jejunostomy. Median hospital length-of-stay was 3 days and 8 (5.6%) patients required admission to the intensive care unit. Postoperative complications occurred in 22 (15.5%) patients within 30 days of the procedure. There were no inpatient deaths; one patient (0.7%) died within 30 days following discharge and three additional deaths (2.1%) occurred through 90 days of follow-up.Conclusions: This approach resulted in excellent clinical outcomes, including short hospital stays with limited need for the intensive care unit, few perioperative complications, and relatively few patients requiring feeding tubes on discharge. This comprehensive approach to esophagectomy is feasible and provides another clinically meaningful advance in the progress of minimally invasive esophagectomy. Further development and dissemination of this method is warranted.

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“…Strategies to successfully implement ERAS include ensuring patients are engaged, physicians embrace the change, support staff fully vest into the program, and executive leaders allow for the appropriate foundation for ERAS execution. [ 15 ] In the next decade as ERAS protocols gain appeal as a means to reduce health care cost, it is expected that findings from primary research projects focused on ERAS protocols will spur the development of new ERAS guidelines.…”

Section: Enhanced Recovery After Surgery Pathway Developmentmentioning

confidence: 99%

“…The team extends beyond the conventional surgical team, which historically included surgeons, anesthesiologists, nurses, and perioperative staff and now incorporates pharmacists, physical therapists, occupational therapists, dieticians, health educators, program managers, patient care coordinators, a pain management team, emergency medicine personnel, and most notably the patient. [ 15 ] Coordinating the efforts of the ERAS team is the ERAS program facilitator. The ERAS facilitator will likely provide guidance, deliver memos and emails, implement rules and regulations, manage the logistics of the perioperative team, and train new personnel.…”

Section: Enhanced Recovery After Surgery Teammentioning

confidence: 99%

See 1 more Smart Citation

Implementing enhanced recovery pathways to improve surgical outcomes

Patil

Cornett

Jesunathadas

et al. 2019

J Anaesthesiol Clin Pharmacol

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The Kaiser Permanente Northern California Enhanced Recovery After Surgery Program: Design, Development, and Implementation

Cited by 17 publications

References 29 publications

A refined procedure for esophageal resection using a full minimally invasive approach

A refined procedure for esophageal resection using a full minimally invasive approach

A Refined Procedure for Esophageal Resection Using a Full Minimally Invasive Approach

Implementing enhanced recovery pathways to improve surgical outcomes

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