Enhanced Recovery After Surgery (ERAS) Pathway in Esophagectomy: Is a Reasonable Prediction of Hospital Stay Possible?

Enhanced Recovery After Surgery (ERAS) Pathway in Esophagectomy: Is a Reasonable Prediction of Hospital Stay Possible?

Parise et al. Ann Surg. 2019 Jul;270(1):77-83. doi: 10.1097/SLA.0000000000002775.

What is already known:
An oeshophagectomy is probably the surgery with the biggest surgical stress response. It has high rates of morbidity and so patients undergoing this type of operation would have the most to gain from a comprehensive ERAS pathway. The ERAS society have recently published guidelines on the perioperative care of these patients, which can be found here.
A general difficulty in ERAS, is to predict which patients will fail to follow a pathway. If we could predict, then we could allocate time and resources to those who were at risk of not following the pathway.

What this paper adds:
The authors of this study attempted to come up with an Enhanced Recovery Predicting Score based on multivariate regression analysis of almost 300 patients who had previously followed an ERAS pathway for oesophagectomy. It included variables such as if a patients ASA score was greater than or equal to 3, if surgery lasted longer than 255 minutes, if non-hybrid surgical approaches were used and whether patients were able to meet their initial mobilisation goals. The authors then used this scoring system to a prospective cohort of patients undergoing surgery at their institution. The score had a sensitivity of 96.6% but the specificity was only 17.6%, so it may not be the definitive answer but is certainly a good start.

Chris Jones, Guildford. @chrisnjones