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Oesophageal I
PTU-177 Reduction in length of stay for patients undergoing major upper gastrointestinal resections with implementation of enhanced recovery packages
  1. E Gemmill1,
  2. J Tang1,
  3. D Humes2,
  4. P Daliya3,
  5. N Welch1,
  6. S Parsons1,
  7. J Catton1
  1. 1UGI Surgery, Nottingham City Hospital, Nottingham, UK
  2. 2Nottingham Digestive Disease Centre and Biomedical Research Unit, Nottingham, UK
  3. 3General Surgery, Nottingham City Hospital, Nottingham, UK

Abstract

Introduction The high mortality and morbidity associated with resection for gastro-oesophageal malignancy has resulted in a conservative approach to the post-operative management of this patient group. In August 2009 an Enhanced Recovery After Surgery (ERAS) pathway tailored for patients undergoing resection for gastro-oesophageal malignancy was introduced. We aimed to assess the impact of this change in practice on standard clinical outcomes.

Methods We performed a retrospective review of two cohorts of patients undergoing resection for gastro-oesophageal malignancy before (08/08–07/09) and after (08/09–07/10) the implementation of the ERAS pathway. Data were collected on demographics, interventions, length of stay, morbidity and in hospital mortality.

Results There were 53 and 55 gastro-oesophageal resections undertaken in each year for malignant disease. The median length of stay for both gastric and oesophageal resection decreased from 15 to 11 days (p<0.001) following the implementation of the ERAS pathway. There was no increase in morbidity (gastric resection 23.1% vs 5.3% and oesophageal resection 25.9% vs 16.7%) or mortality (gastric resection no deaths and oesophageal resection 1.8% vs 3.6%) associated with the changes. There was a significant decrease in the number of oral contrast studies used following oesophageal resection with a reduction from 21 (77.8%) in 2008–2009 to 6 (16.7%) in 2009–2010 (χ2, p<0.0001).

Conclusion The introduction of an enhanced recovery programme following gastro-oesophageal surgery resulted in a significant decrease in length of median patient stay in hospital without a significant increase in associated morbidity and mortality.

Competing interests None declared.

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