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      Fit-for-Discharge Criteria after Esophagectomy: An International Expert Delphi Consensus.

      1 , 1 , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 16 , 18 , 19 , 20 , 21 , 15 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 20 , 28 , 33 , 34 , 1
      Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
      Oxford University Press (OUP)
      Delphi consensus, discharge criteria, esophagectomy, hospital stay

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          Abstract

          There are no internationally recognized criteria available to determine preparedness for hospital discharge after esophagectomy. This study aims to achieve international consensus using Delphi methodology. The expert panel consisted of 40 esophageal surgeons spanning 16 countries and 4 continents. During a 3-round, web-based Delphi process, experts voted for discharge criteria using 5-point Likert scales. Data were analyzed using descriptive statistics. Consensus was reached if agreement was ≥75% in round 3. Consensus was achieved for the following basic criteria: nutritional requirements are met by oral intake of at least liquids with optional supplementary nutrition via jejunal feeding tube. The patient should have passed flatus and does not require oxygen during mobilization or at rest. Central venous catheters should be removed. Adequate analgesia at rest and during mobilization is achieved using both oral opioid and non-opioid analgesics. All vital signs should be normal unless abnormal preoperatively. Inflammatory parameters should be trending down and close to normal (leucocyte count ≤12G/l and C-reactive protein ≤80 mg/dl). This multinational Delphi survey represents the first expert-led process for consensus criteria to determine 'fit-for-discharge' status after esophagectomy. Results of this Delphi survey may be applied to clinical outcomes research as an objective measure of short-term recovery. Furthermore, standardized endpoints identified through this process may be used in clinical practice to guide decisions regarding patient discharge and may help to reduce the risk of premature discharge or prolonged admission.

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          Author and article information

          Journal
          Dis Esophagus
          Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
          Oxford University Press (OUP)
          1442-2050
          1120-8694
          Jun 14 2021
          : 34
          : 6
          Affiliations
          [1 ] Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
          [2 ] IRCCS Policlinico San Donato, Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
          [3 ] Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
          [4 ] Department of Surgery, Vall d'Hebron Hospital, Barcelona, Spain.
          [5 ] Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
          [6 ] Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
          [7 ] Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
          [8 ] Departments of Surgery and Oncology, Montreal General Hospital, McGill University, Montreal, Canada.
          [9 ] Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands.
          [10 ] Department of Visceral, Thoracic, Transplant and Vascular surgery, University Hospital of Leipzig, Leipzig, Germany.
          [11 ] Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
          [12 ] Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, USA.
          [13 ] Center for Oesophageal and Gastric Surgery, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany.
          [14 ] Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, USA.
          [15 ] Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
          [16 ] Imperial College Healthcare NHS Trust and Imperial College, London, UK.
          [17 ] Division of Visceral Surgery, Department of Surgery, University of Geneva, Hospitals and School of Medicine, Geneva, Switzerland.
          [18 ] Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, USA.
          [19 ] Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
          [20 ] Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium.
          [21 ] Esophageal Institute, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina.
          [22 ] Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
          [23 ] Department of Surgical Gastroenterology, GEM Hospital & Research Centre, Coimbatore, India.
          [24 ] Department of Surgery, University Center Ghent, Ghent, Belgium.
          [25 ] Department of Surgery, Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
          [26 ] Department of General Thoracic and Esophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland.
          [27 ] Department of Gastroenterology, Cancer Institute, University of São Paulo Medical School, São Paulo, Brazil.
          [28 ] Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
          [29 ] Department of General, Visceral and Cancer Surgery, University of Cologne, Germany.
          [30 ] Department of Upper GI Surgery, Oxford University Hospitals, UK.
          [31 ] General Surgery Department, AMC-Academic Medical Center, Amsterdam, The Netherlands.
          [32 ] Department of Surgical Oncology, University Medical Center Utrecht, The Netherlands.
          [33 ] Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, Australia.
          [34 ] Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
          Article
          5909885
          10.1093/dote/doaa101
          32960264
          b7d764db-60be-41f3-8e59-34c0d7f01fe4
          History

          Delphi consensus,hospital stay,discharge criteria,esophagectomy

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