Standardized Postoperative Recovery Reduces in-Hospital Stay After Minimally Invasive Esophagectomy

Background: This study aims to examine if a standardized enhanced recovery program (ERP) could reduce the length of stay (LOS) after minimally invasive esophagectomy (MIO) compared to the earlier applied recovery program without increasing the risk of postoperative complications and readmissions. Methods: Retrospective study of patients with esophageal and gastroesophageal junction cancer who have had an uncomplicated postoperative stay following MIO. Patients had followed two different postoperative recovery programs according to their year of surgery (2016 versus 2018). Results: 48 patients in 2016 and 42 patients in 2018 were included. Patients were comparable on demographic factors. The median LOS was reduced from 9 days in 2016 to 8 days in 2018 (p<0.001). In 2018, 27 patients (64.3%) fulfilled the aim of discharge to their own home on day 8 after surgery. There was no significant difference (p>0.05) between the two groups in the risk of complications (Clavien-Dindo degree 0-2). Two patients in 2016 (4.2%) and two patients in 2018 (4.8%) were readmitted within 7 days after discharge (not significant). There was no in-hospital mortality or 30-day mortality in either of the two groups. Conclusion: The introduction of an ERP at our institution reduced the median postoperative stay after MIO by one day without increasing the risk of complications and readmittance. Further reduction might be obtained if oral feeding is allowed earlier.