STANDARDIZED CLINICAL PATHWAYS FOR ESOPHAGECTOMY ARE NOT A REALITY IN BRAZIL,EVEN WITH A HIGH PREVALENCE OF ESOPHAGEAL CANCER AND ACHALASIA

Background:

The adoption of standardized protocols and specialized multidisciplinary teams foresophagectomy involve changes in routines with the implantation of expensiveclinical practices and deviations from ingrained treatment philosophies.

Aim:

To evaluate the prevalence of standardized protocols and specializedmultidisciplinary teams in São Paulo state, Brazil.

Methods:

Institutions that routinely perform esophagectomies in São Paulo were contactedand questioned about the work team involved in the procedure and the presence ofstandardized routines in the preoperatory care.

Results:

Fifteen centers answered the questionnaire: 10 (67%) public institutions and five(33%) private. There were seven (47%) medical schools, six (40%) with a residencyprogram and two (13%) nonacademic institutions. The mean number of esophagectomiesper year was 23. There was a multidisciplinary pre-operative team in nine (60%).There was a multidisciplinary postoperative team in 11 (73%). Early mobilizationprotocol was adopted in 12 (80%) institutions, early feeding in 13 (87%),routinely epidural in seven (47%), analgesia protocol in seven (47%), hydricrestriction in six (40%), early extubation in six (40%), standardizedhospitalization time in four (27%) and standardized intensive care time in two(13%).

Conclusion:

The prevalence of standardized protocols and specialized teams is very low in SaoPaulo state, Brazil. The presence of specialized surgeons is a reality andstandardized protocols related directly to surgeons have higher frequency thanthose related to other professionals in the multidisciplinary team.