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World Journal of Surgery

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01-07-2016 | Original Scientific Report

Propensity Score Analysis of an Enhanced Recovery Programme in Upper Gastrointestinal Cancer Surgery

Authors: A. Karran, J. Wheat, D. Chan, P. Blake, R. Barlow, W. G. Lewis

Published in: World Journal of Surgery | Issue 7/2016

Abstract

Introduction

The aim of this study was to examine the influence of an enhanced recovery programme (ERP) on outcomes of upper gastrointestinal (UGI) cancer surgery by means of propensity score-matched analysis.

Methods

Three hundred consecutive patients diagnosed with UGI cancer were studied prospectively before and after the introduction of an ERP. Multiple regression models, including propensity scores, were developed to assess confounding variables associated with undergoing surgery, and the risk adjusted association between treatment and length of hospital stay (LOHS).

Results

After regression for confounding factors, a cohort of 252 patients was available of whom 160 received ERP [median age 66 years (IQR 58–73), 119 male, 81 oesophageal, 79 gastric cancer] and 92 control [66 years (IQR 58–74), 74 male, 58 oesophageal, 34 gastric cancer]. ERP operative morbidity (Clavien–Dindo ≥3) and mortality were 13.8 and 3.1 % compared with 17.4 (p = 0.449) and 2.2 % (p = 0.658) in controls. Median ERP critical care and total LOS were 1 (IQR 0–1) and 13 (IQR 10–17) days, compared with 1 (IQR 1–2, p = 0.009) and 16 (IQR 13–26, p < 0.001) days. Multivariable analysis revealed ERP (HR 1.477, 95 % CI 1.084–2.013, p = 0.013), tumour location (HR 2.420, 95 % CI 1.624–3.606, p < 0.001), operative procedure (HR 1.143, 95 % CI 1.032–1.265, p = 0.010), and operative morbidity (HR 0.277, 95 % CI 0.179–0.429, p < 0.001) to be associated with LOHS.

Conclusion

An ERP in UGI cancer surgery was feasible, safe, and effective.

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Title: Propensity Score Analysis of an Enhanced Recovery Programme in Upper Gastrointestinal Cancer Surgery
Authors: A. Karran
J. Wheat
D. Chan
P. Blake
R. Barlow
W. G. Lewis
Publication date: 01-07-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3473-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Propensity Score Analysis of an Enhanced Recovery Programme in Upper Gastrointestinal Cancer Surgery

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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