Esophagectomy Enhanced Recovery After Surgery Initiative Results in Improved Outcomes

Esophagectomy for esophageal cancer is a procedure with high morbidity and mortality. We studied a multidisciplinary esophagectomy enhanced recovery initiative team (MERIT) pathway and analyzed implementation outcomes in a single institution.A MERIT pathway was developed as a practice optimization and quality improvement initiative. Patients were studied from 11/1/2021 to 6/20/2022 and compared to historical controls. Wilcoxon rank sum test and Fisher's exact test were used for statistical analysis.We compared 238 historical patients (1/17/2017 to 12/30/2020) to 58 consecutive MERIT patients. There were no significant differences between patient characteristics in the two groups. In the MERIT group, 49 (85%) were male, mean age was 65 years (range 59-71). Most cases were performed for esophageal cancer after neoadjuvant therapy. Length of stay improved 27% from 11 to 8 days (p = 0.27). There was a 12% (p = 0.05) atrial arrhythmia rate reduction, and a 9% (p = 0.01) decrease in postoperative ileus. Overall complications were reduced from xx to xx (p= ) CONCLUSIONS: We successfully developed and implemented an ERAS pathway for esophagectomy. In our first year, we were able to reduce overall complications, atrial arrhythmias, and post-operative ileus.