Esophagectomy outcomes exceed national average at safety-net hospital with standardized protocol
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A “safety-net” hospital in Florida that followed a standardized protocol when managing patients who underwent esophagectomy was able to achieve lower complication rates than the national average, according to research published in the Journal of the American College of Surgeons.
Lori A. Gurien, MD, MPH, chief surgical resident at the University of Florida College of Medicine–Jacksonville, and colleagues wrote that the findings run counter to previous data that suggested these “hospitals of last resort” had suboptimal results compared with nonsafety-net hospitals.
“What we think and what we discovered is that it’s not because the hospital gives us more money and resources for the surgical oncology portion,” Gurien said in a press release. “It is that we figured out a way to use resources in a smarter way than other places that may not have the limitations that we have at our hospital.”
The surgical team at University of Florida Health-Jacksonville (UFH) utilizes a clinical pathway to guide patients through every step before and after their procedure. A staff surgical navigator walks patients and their families through every aspect of the process from planning to follow-up. Gurien said they do not deviate from the pathway except for in unforeseen situations.
Gurien and colleagues analyzed a group of 78 patients who underwent esophagectomy between September 2013 and January 2017, and they compared outcomes with a group of 1,825 patients who underwent the same procedure nationally in the American College of Surgeons National Surgical Quality Improvement Program.
The investigators looked at three primary outcomes used as quality measures for surgeries — complications, number of second and third operations, and length of hospital stay. UFH had significantly lower complication rates (16.7% vs. 33.3%, P = 0.003), lower reoperation rates (6.4% vs. 14.5%, P = 0.046) and shorter average length of hospital stay(10.3 days vs. 13.1 days, P = 0.001).
“The takeaway from this study is that good outcomes are more a result of the process,” Gurien said in the press release. “I do think other hospitals can perform this process, especially safety-net hospitals like ours that have limited financial resources.” – by Alex Young
Disclosures: The authors reported no relevant financial disclosures.