P162 ENHANCED RECOVERY PROTOCOL COMPLIANCE AND CLINICAL OUTCOMES IN ESOPHAGECTOMY FOR CANCER: DESIGN OF A MEASURING INSTRUMENT

Objectives Success of an enhanced recovery program (ERP) is not easily measured/quantified. Can a newly developed measuring instrument help to determine compliance and thus success of an ERP? Methods From the introduction of our ERP (May 2017), 200 consecutive potential curative esophagectomies for cancer were reviewed. A newly developed instrument with 12 prospectively recorded benchmarks was used to measure compliance. Each patient was scored for all benchmarks, reflecting how well the protocol-timeline was followed. A mean score of ≥70% of all benchmarks in a patient is considered compliant with the ERP-protocol. Results Sixty-three percent (125/200) of the patients were compliant (Fig1A). Compliance to the ERP showed significant beneficial effects on clinical outcomes: the comprehensive complications index was significantly lower in the compliant group compared to the not-compliant group: 22.6 versus 43.3; p<0.0001. This resulted in a significant lower median (IQR) length of stay between both groups: 9 (8-10) days versus 14 (11-22) days; p<0.0001. Some of the benchmarks showed a direct relation to individual complications, e.g. the percentage of pneumonias is correlated to the benchmark ‘active mobilization on postoperative day1’ (Fig1B) Conclusion Higher compliance to the ERP protocol helps to reduce postoperative complications and thus shortens the postoperative hospital stay.