Short-term Postoperative Outcomes Before and After the Establishment of the Siriraj Upper Gastrointestinal Cancer Center: A Propensity Score Matched Analysis

Authors

  • Chawisa Nampoolsuksan Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0002-5990-4704
  • Thammawat Parakonthun Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0002-2990-0649
  • Thikhamporn Tawantanakorn Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. http://orcid.org/0000-0001-8468-4347
  • Andres Mora Hospital of Specialties “Carlos Andrade Marin”, Quito, Ecuador http://orcid.org/0000-0002-4532-4653
  • Jirawat Swangsri Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0003-3721-1859
  • Thawatchai Akaraviputh Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0003-2969-2648
  • Asada Methasate Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0002-8726-365X
  • Anusak Yiengpruksawan Capital Health Cancer Center, Pennington, New Jersey, USA http://orcid.org/0000-0002-9439-958X
  • Vitoon Chinswangwatanakul Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0001-9662-1669

DOI:

https://doi.org/10.33192/Smj.2020.43

Keywords:

Gastric cancer, esophagogastric junction, gastrectomy, multidisciplinary team, centralization, Enhanced Recovery After Surgery (ERAS)

Abstract

Objective

To evaluate short-term postoperative outcomes compared between before and 1 year after the establishment of the Siriraj Upper Gastrointestinal Cancer Center (UGICC).

Materials and Methods

Medical records of 211 patients who underwent radical gastrectomy at Siriraj Hospital during January 2012-September 2018 were reviewed (before UGICC; B-UGICC). Data of 40 patients operated upon during October 2018-September 2019 were prospectively collected after the establishment of UGICC (A-UGICC). Propensity score (PPS) matched analysis was conducted, and short-term outcomes were compared. Enhanced Recovery After Surgery (ERAS) protocol was applied to some patients in A-UGICC. Results of conventional care (CC) were compared with ERAS protocol.

Results

PPS matched 78 patients in B-UGICC, and 40 patients in A-UGICC. Median postoperative length of stay (POS) was significantly shorter in A-UGICC than in B-UGICC; however, complications and time to oral diet tolerability were not significantly different between groups. In A-UGICC, median POS and time to toleration of oral diet were significantly shorter among 15 ERAS patients than among 25 CC patients. Intestinal recovery and time to ambulation trended to be earlier in ERAS. 103 CC and 15 ERAS patients were matched to 36 non-ERAS and 13 ERAS patients. Median time to toleration of oral diet was significantly shorter in ERAS than in CC (P<0.001). Median POS was significantly shorter in ERAS (P<0.001). Postoperative complications were non-significantly different between ERAS and CC. There was no mortality in this study.

Conclusion

UGICC with multidisciplinary team approach contributed to improvement of postoperative short-term outcomes.

Downloads

Published

09-05-2020

How to Cite

Nampoolsuksan, C., Parakonthun, T., Tawantanakorn, T. ., Mora, A. ., Swangsri, J. ., Akaraviputh, T. ., Methasate, A. ., Yiengpruksawan, A. ., & Chinswangwatanakul, V. . (2020). Short-term Postoperative Outcomes Before and After the Establishment of the Siriraj Upper Gastrointestinal Cancer Center: A Propensity Score Matched Analysis. Siriraj Medical Journal, 72(4), 215–320. https://doi.org/10.33192/Smj.2020.43

Issue

Section

Original Article