Multidisciplinary team management to prevent complications after esophagectomy

Abstract

In April 2017, we launched the multidisciplinary Hamamatsu Perioperative Care Team (HOPE) for all surgical patients. We developed a reinforced intervention strategy, particularly for esophagectomy. We investigated risk factors for surgical site infection (SSI) in esophagectomy and report the outcomes of the HOPE. In all, 122 patients underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between January 2012 and December 2017 in the Department of Surgery of Hamamatsu University School of Medicine. The patients were divided into the pre–HOPE group, which included 96 patients who underwent esophagectomy before the introduction of the HOPE, and the HOPE group, which included 26 patients who underwent esophagectomy after the introduction of the HOPE. Complications were graded according to the Clavien–Dindo Classification. Of the 122 patients analyzed, 25 were diagnosed with incisional SSI (＞gradeⅡ) and 24 were diagnosed with organ/space SSI (＞gradeⅡ). A univariate analysis showed that a preoperative Onodera’s prognostic nutritional index ＜45 and a Controlling Nutritional Status ＞2 were risk factors for incisional SSI, and low total protein and cholinesterase levels were risk factors for organ/space SSI. The incidence rates of organ/space SSI were lower in the HOPE group than in the pre–HOPE group (8％ vs. 22％, P=0.066). Preoperative poor nutritional status was a risk factor for SSIs. Therefore, multidisciplinary team care was effective in preventing SSIs.