P1.213. Pushing Toward Routine POD 5 Discharge After RAMIE Within a Mature ERAS Environment May Safely Reduce Length of Stay

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background ERAS pathways have shortened hospital stay after esophagectomy, yet discharge timing remains variable, particularly after robotic approaches. Early discharge (POD 5–6) has been shown to be feasible and safe in selected patients, but evidence specific to robotic-assisted minimally invasive esophagectomy (RAMIE) is limited. Observing progressively earlier discharge among uncomplicated patients, we revised our target discharge from POD 7 to POD 5. This study evaluates the safety and feasibility of a POD 5 discharge protocol compared with a prior POD 7 pathway in a high-performance center. Methods Consecutive patients undergoing RAMIE were analyzed before and after implementation of a postoperative day five discharge pathway (ERAS POD5). Outcomes included length of hospital stay (LOS) and 30-day readmission. Multivariate regression adjusted for clinical covariates. Results A total of 343 patients were included (POD7: n=221; POD5: n=122). Median LOS was shorter following POD5 pathway implementation (6 days [IQR 5–7] vs 8 days [IQR 7–11]; p<0.001). Unadjusted linear regression showed an apparent association with a shorter LOS (β = −3.21 days; 95% CI −5.34 to −1.08; p=0.003; R2=0.050). The association remained significant after multivariate adjustment (β = −3.26 days; 95% CI −5.62 to 0.90; p=0.007; R2=0.030). Thirty-day readmission rates were similar between groups (ERAS POD7: 12.4% vs ERAS POD5: 12.0%). ERAS POD5 discharge was not associated with increased readmission risk in unadjusted (OR 0.97, 95% CI 0.50–1.90) or adjusted analyses (adjusted OR 1.15, 95% CI 0.39–3.44). No increase in severe (Clavien–Dindo ≥III) readmission-related complications was observed. Conclusion Implementation of a POD 5 discharge pathway was associated with a safe reduction of hospitalization within a mature ERAS environment.