Cherie P. Erkmen
Temple University Health Systems, USA
Cherie P. Erkmen, MD attended the UCLA School of Medicine and Brigham & Women’s Hospital for general surgery residency and cardiothoracic fellowship. She is currently an Associate Professor at Temple University Medical School.
Introduction: Clinical pathways have been shown to shorten hospitalization and decrease costs in colorectal and pancreatic cancer. We describe the methodology of creating an esophagectomy pathway and analyze its implementation and effects on outcomes and costs.
Methods: We documented the process of developing an esophagectomy clinical pathway. We performed a retrospective review of prospectively collected data on 12 patients before pathway implementation and 12 patients after.
Results: Pathway Implementation: More patients had a pre-operative anesthesia consult (11 vs. 0; p<0.0001), were presented at tumor board (9 pathway vs. 2 pre-pathway; p=0.012), and chose their postoperative care facility before surgery (8 vs. 0; p=0.0013) Outcomes: There were no changes in mortality (0 vs. 0), major complications (5 vs. 5), hospitalization period (median 9.5 vs. 12 days; p=0.82), and total costs charges ($98395 vs. $96946; p=0.96). However, pathway patients lost significantly less weight preoperatively (2.3% vs. 7.6%; p=0.012) and perioperatively (6.3% vs. 12%; p=0.021).
Conclusions: To our knowledge, this is the first study to report the process of designing, implementing, and measuring clinical and financial outcomes of an esophagectomy pathway. While there was no significant decrease in mortality, complications, hospitalization, or charges, our pathway significantly decreased pre- and perioperative weight loss. We attribute this improvement in clinical outcome to coordinated patient education and care.