Authors Y. MANDEVILLE (1), J. MOONS (1), A. RINGOET (1), L. DEPYPERE (1), W. COOSEMANS (1), H. VAN VEER (1), P. NAFTEUX (1) / [1] UZ Leuven, Leuven, Belgium, thoracic surgery Introduction Enhanced recovery pathways (ERP) are well established in several surgical disciplines and have the potential to improve clinical outcome even after complex procedures, such as esophagectomy. In a stepwise implementation of ERP in esophagectomy patients, early mobilization (transition period-TP) was introduced in September 2016 in our department. Subsequently, a complete ERP was implemented in May 2017. Aim Purpose of this study was to determine the impact of a new ERP on perioperative results as compared to our traditional care after esophagectomy (TC). Methods For this observational study independent samples t-test and Fisher's exact test were used to calculate statistical differences between groups. A propensity score matching was performed to reduce the bias due to confounding variables. The nearest neighbour matching procedure (1:1) was used. Differences were considered to be significant when p < 0.05. Results There were 160 TC and 50 ERP patients. No differences were found neither in patient demographics, comorbidities, tumor characteristics nor in treatment types (table 1). A significant decrease in complications was found between the two groups, especially pneumonia and respiratory failure requiring reintubation (38% in TC and 16% in ERP; p= 0.0007 and 16% versus 4%; p= 0.026 respectively) and postoperative blood transfusion (26%-4%; p=0.003). Furthermore, a clear but non-significant reduction in anastomotic leak rates (12%-4%; p= 0.11), delirium (6%-2%; p=0.24), central line infections (10%-0%) was found (table 2). Consequently, CCI% was statistically different between the groups: TC 38.1% vs. ERP 28.2% (p= 0.03). Furthermore, median LOS was also significantly shortened from 13 days (IQR 10-20) in TC to 9 days (IQR 8-13) in ERP patients (p= 0.009). The 30-day readmission rate (10% in TC and 10% in ERP) was not significantly affected. Forty-seven ERP-patients could be matched to 47 TC-patients in a propensity analysis in which 11 variables were used to ensure an even distribution of confounders between groups (table 3). This analysis confirmed the significant impact on pneumonia (p=0.032); blood transfusion (p= 0.021) and LOS (p= 0.022) (table 4). Conclusions In this prospective observational study, a clear decrease in complication rate (especially respiratory complications) and CCI% were observed after ERP introduction, leading to a shortening of LOS without affecting the 30-day readmission rate. A propensity analysis confirmed the positive impact of ERP on pneumonia and LOS without impact on readmission rate. ERP for esophagectomy in a tertiary referral center is associated with a significant decrease in postoperative (respiratory) complications which results in a significant decrease of LOS without affecting readmission rate.
