Decision analysis supports the use of drain amylase-based enhanced recovery method after esophagectomy

Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus
B JiangChristopher W Towe

Abstract

Postesophagectomy anastomotic leak is a common postsurgical complication. The current standard method of detecting leak is esophagram usually late in the postoperative period. Perianastomotic drain amylase level had shown promising results in early detection anastomosis leak. Previous studies have shown that postoperative day 4 amylase level is more specific and sensitive than esophagram. The purpose of this study is to determine if implementing a drain amylase-based screening method for anastomotic leak can reduce length of stay and hospital cost relative to a traditional esophagram-based pathway. The drain amylase protocol we propose uses postoperative day 4 drain amylase level to direct the initiation of PO intake and discharge. We designed a decision analysis tree using TreeAge Pro software to compare the drain amylase-based screening method to the standard of care, the esophagram. We performed a retrospective review of postesophagectomy patients from a tertiary academic medical center (University hospital Cleveland medical center) where amylase level was measured routinely postoperatively. The patients were separated into amylase-based pathway group and the standard of care group based on their postop management. The lengt...Continue Reading

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Citations

Jun 2, 2020·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·M FabbiS S Gisbertz
Dec 29, 2018·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Luca GiuliniHubert J Stein
May 12, 2019·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·James BundredEwen A Griffiths
Feb 5, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Woo Sik YuSeong Yong Park
Sep 11, 2020·Computational and Mathematical Methods in Medicine·Lucia Reis Peixoto RoselliAdiel Teixeira de Almeida
Feb 13, 2021·Computational and Mathematical Methods in Medicine·Eduarda Asfora FrejAdiel Teixeira de Almeida
Feb 11, 2021·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Antonio BarbaroJonathan Shenfine
Sep 30, 2021·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Alexander BullJames A Gossage
Nov 10, 2021·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·Mikolaj KowalDavid Jayne
Aug 27, 2021·The Annals of Thoracic Surgery·Philip A LindenYaron Perry

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