Association between ERAS protocol and major postoperative complications and reasons for non-compliance in patients with esophageal cancer

Introduction: The association between each Enhanced Recovery After Surgery (ERAS) component and the incidence of major postoperative complications following Ivor Lewis or McKeown surgery is understudied. Therefore, we wanted to determine the association between ERAS components, major postoperative complications, and the reasons for non-compliance with the ERAS program. Methods: Data were extracted from the prospective ERAS Registry managed by the University of Verona, Italy. We searched and compared the data for postoperative major complications (Clavien-Dindo Classification >= 3B) and reasons for non-compliance with 15 ERAS items in patients undergoing Ivor Lewis or McKeown surgery with radical intent for esophageal or esophagogastric junction cancer. Results: The study sample was 346 patients: 43 (12.4 %) experienced one or more postoperative major complications. When stratified by type of surgery, complications were more frequent after McKeown surgery than after Ivor Lewis surgery (15.5 % and 11.5 %, respectively). Organizational setbacks were the most common reason for non-compliance with the ERAS program. We identified several associations between clinical and patient demographic characteristics and 90-day postsurgical complications. The multivariate model indicated an association between fewer major postoperative complications after Ivor Lewis surgery and adherence to the protocol items "soft diet intake" (adjusted odds ratio [OR], 0.23; 95 % confidence interval [CI], 0.08-0.63) and "urinary catheter removal" (adjusted OR, 0.26; 95 % CI, 0.10-0.63). Discussion/conclusions: Major complications are relatively frequent, especially after McKeown surgery. What remains uncertain is whether ERAS items can predict the occurrence of postoperative complications. Adherence to the protocol may be influenced by the co-occurrence of complications, comorbidities, and organizational setbacks.