Results of an Enhanced Recovery after Surgery Protocol for Upper Gastrointestinal Surgery at a Super-Tertiary Referral Hospital in Thailand

Background: Enhanced recovery after surgery (ERAS) protocol has been shown to reduce recovery period and postoperative complications.This prospective study aimed to evaluate the short-term outcomes of ERAS in patients who underwent upper gastrointestinal (UGI) surgery.Methods: Patients who underwent surgery for benign or malignant diseases of the esophagus, esophagogastric junction, or stomach during October 2018-December 2019 were included.Outcomes compared between ERAS and conventional care (CC) included length of hospital stay (LOS), postoperative complications, mortality, recovery, and hospitalization cost.Results: Eighty-eight (32 ERAS, 56 CC) patients were included.ERAS had shorter LOS (5.5 vs. 12.5 days, p<0.001), earlier time to toleration of oral soft diet (3 vs. 8 days, p<0.001), faster time to first defecation (71.6 vs. 114.5 hours, p<0.001), early ambulation (43.8 vs. 84.6 hours, p=0.010), and reduced hospitalization cost (197,140 vs. 256,315 Thai baht, p<0.032).C-reactive protein level on postoperative day 1 was significantly lower in ERAS patients (61.3 vs. 87.9mg/L, p=0.027).BMI recovery occurred within 3 and 6 months in ERAS and CC, respectively.There was no significant difference in surgery-related or nonsurgery-related complications between groups.No mortality was observed.Conclusions: In a UGI surgical setting, ERAS accelerated recovery, reduced LOS, and lowered hospitalization cost.