Enhanced Recovery After Surgery can Improve Patient Outcomes and Reduce Hospital Cost of Gastrectomy for Cancer in the West: A Propensity-Score-Based Analysis.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
04
01
2021
accepted:
10
04
2021
pubmed:
15
5
2021
medline:
21
10
2021
entrez:
14
5
2021
Statut:
ppublish
Résumé
Data on ERAS for gastrectomy are scarce, and the majority of the studies come from Eastern countries. Patients in the West are older and suffer from more advanced tumors that impair their clinical condition and often require neoadjuvant treatment. This retrospective study assessed the feasibility and safety of an Enhanced Recovery After Surgery (ERAS) protocol for gastrectomy in a Western center. We conducted a single-center study of 351 patients operated for gastric cancer: 103, operated from January 2015 to December 2016, followed the standard pathway, while 248, operated from January 2017 to December 2019, followed the ERAS program. The primary outcomes considered were length of hospital stay (LOS) and direct costs. Secondary outcomes were 90-day morbidity and mortality, readmission rate, and compliance with ERAS items. A propensity score (PS) was built on confounding variables. Compliance with ERAS items after the program was ≥ 70%. Univariable analysis evidenced a 2-day median reduction in LOS and a median cost reduction of €826 per patient in the ERAS group. PS-based multivariable analysis confirmed a significant, 2-day decrease in median LOS and a €1097 saving after ERAS introduction. Ninety-day mortality decreased slightly in ERAS group, while complications and readmissions did not change significantly. When complications were included in the multivariable analysis, ERAS retained its significance, although the effects on LOS and cost were blunted to a median reduction of 1 day and €775, respectively. ERAS for gastrectomy improved patients' recovery and reduced hospital costs without changes in morbidity, mortality, or readmission.
Sections du résumé
BACKGROUND
BACKGROUND
Data on ERAS for gastrectomy are scarce, and the majority of the studies come from Eastern countries. Patients in the West are older and suffer from more advanced tumors that impair their clinical condition and often require neoadjuvant treatment. This retrospective study assessed the feasibility and safety of an Enhanced Recovery After Surgery (ERAS) protocol for gastrectomy in a Western center.
METHODS
METHODS
We conducted a single-center study of 351 patients operated for gastric cancer: 103, operated from January 2015 to December 2016, followed the standard pathway, while 248, operated from January 2017 to December 2019, followed the ERAS program. The primary outcomes considered were length of hospital stay (LOS) and direct costs. Secondary outcomes were 90-day morbidity and mortality, readmission rate, and compliance with ERAS items. A propensity score (PS) was built on confounding variables.
RESULTS
RESULTS
Compliance with ERAS items after the program was ≥ 70%. Univariable analysis evidenced a 2-day median reduction in LOS and a median cost reduction of €826 per patient in the ERAS group. PS-based multivariable analysis confirmed a significant, 2-day decrease in median LOS and a €1097 saving after ERAS introduction. Ninety-day mortality decreased slightly in ERAS group, while complications and readmissions did not change significantly. When complications were included in the multivariable analysis, ERAS retained its significance, although the effects on LOS and cost were blunted to a median reduction of 1 day and €775, respectively.
CONCLUSIONS
CONCLUSIONS
ERAS for gastrectomy improved patients' recovery and reduced hospital costs without changes in morbidity, mortality, or readmission.
Identifiants
pubmed: 33988796
doi: 10.1245/s10434-021-10079-x
pii: 10.1245/s10434-021-10079-x
pmc: PMC8519899
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7087-7094Informations de copyright
© 2021. The Author(s).
Références
Mortensen K, Nilsson M, Slim K, et al. (Enhanced recovery after surgery - ERAS® group). Consensus guidelines for enhanced recovery after gastrectomy: enhanced recovery after surgery (ERAS®) society recommendations. Br J Surg. 2014;101:1209–29.
doi: 10.1002/bjs.9582
Claassen YHM, van Amelsfoort RM, Hartgrink HH, et al. Association between hospital volume and quality of gastric cancer surgery in the CRITICS trial. Br J Surg. 2018;105:728–35.
doi: 10.1002/bjs.10773
Wang D, Kong Y, Zhong B, Zhou X, Zhou Y. Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg. 2010;14:620–7.
doi: 10.1007/s11605-009-1139-5
Yamada T, Hayashi T, Cho H, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer. 2012;15:34–41.
doi: 10.1007/s10120-011-0057-x
Ji W, Chandoo A, Guo X, You T, et al. Enhanced recovery after surgery decreases intestinal recovery time and pain intensity in patients undergoing curative gastrectomy. Cancer Manag Res. 2018;10:3513–20.
doi: 10.2147/CMAR.S168909
Ding J, Sun B, Song P, et al. The application of enhanced recovery after surgery (ERAS)/fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis. Oncotarget. 2017;8:75699–711.
doi: 10.18632/oncotarget.18581
Fumagalli Romario U, Weindelmayer J, Coratti A, et al. Enhanced recovery after surgery in gastric cancer: which are the main achievements from the Italian experience? Updates Surg. 2018;70:257–64.
doi: 10.1007/s13304-018-0522-8
Bencivenga M, Verlato G, Han DS, et al. Italian Research Group for Gastric Cancer (GIRCG). Validation of two prognostic models for recurrence and survival after radical gastrectomy for gastric cancer. Br J Surg. 2017;104:1235–43.
doi: 10.1002/bjs.10551
Strong VE, Wu AW, Selby LV, et al. Differences in gastric cancer survival between the U.S. and China. J Surg Oncol. 2015;112:31–7.
doi: 10.1002/jso.23940
Kolovou GD, Anagnostopoulou KK, Salpea KD, Mikhailidis DP. The prevalence of metabolic syndrome in various populations. Am J Med Sci. 2007;333:362–71.
doi: 10.1097/MAJ.0b013e318065c3a1
Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2020 Feb 14. Online ahead of print. https://doi.org/10.1007/s10120-020-01042-y
Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, ESMO Guidelines Committee. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27:38–49.
doi: 10.1093/annonc/mdw350
De Manzoni G, Marrelli D, Baiocchi GL, et al. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer. 2017;20:20–30.
doi: 10.1007/s10120-016-0615-3
Clavien PA, Barkun J. de Oliveira ML et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;2:250.
Changsheng H, Shengli S, Yongdong F. Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis. Postgrad Med J. 2020;96:257–66.
doi: 10.1136/postgradmedj-2019-136679
Wee IJY, Syn NL, Shabbir A, Kim G, So JBY. Enhanced recovery versus conventional care in gastric cancer surgery: a meta-analysis of randomized and non-randomized controlled trials. Gastric Cancer. 2019;22:423–30.
doi: 10.1007/s10120-019-00937-9
Karran A, Wheat J, Chan D, Blake P, Barlow R, Lewis WG. Propensity score analysis of an enhanced recovery programme in upper gastrointestinal cancer surgery. World J Surg. 2016;40:1645–54.
doi: 10.1007/s00268-016-3473-6
Desiderio J, Stewart CL, Sun V, et al. Enhanced Recovery after Surgery for gastric cancer patients improves clinical outcomes at a US cancer center. J Gastric Cancer. 2018;18:230–41.
doi: 10.5230/jgc.2018.18.e24
Weindelmayer J, Verlato G. Alberti L et al Enhanced recovery protocol in esophagectomy, is it really worth it? A cost analysis related to team experience and protocol compliance. Dis Esophagus. 2018;32:1–6.
Ljungqvist O, Thanh NX, Nelson G. ERAS-value based surgery. J Surg Oncol. 2017;116:608–12.
doi: 10.1002/jso.24820
Huang ZD, Gu HY, Zhu J, et al. The application of enhanced recovery after surgery for upper gastrointestinal surgery: meta-analysis. BMC Surg. 2020;20:3.
doi: 10.1186/s12893-019-0669-3