Rafael Morales Soriano1, Neus Esteve Pérez2, Silvia Tejada Gavela3, Ángel Cuadrado García4, José Carlos Rodríguez Pino2, José Miguel Morón Canis2, Xavier Molina Romero2, José Muñoz Pérez5, Xavier González Argente2. 1. Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España. Electronic address: rafa.morales@telefonica.net. 2. Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España. 3. Departamento de Biología y Ciencias de la Salud, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España. 4. Servicio de Cirugía General y Digestiva, Hospital Juan Carlos I, Madrid, España. 5. Servicio de Cirugía General y Digestivo, Hospital Son Llátzer, Palma de Mallorca, Baleares, España.
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) has demonstrated in colorectal surgery a reduction in morbidity and length of stay without compromising security. Experience with ERAS programs in pancreatoduodenectomy (PD) is still limited. The aims of this study were first to evaluate the applicability of an ERAS program for PD patients in our hospital, and second to analyze the postoperative results. METHODS: A retrospective study using a prospectively maintained database identified 41 consecutive PD included in an ERAS program. Key elements studied were early removal of tubes and drainages, early oral feeding and early mobilization. Variables studied were mortality, morbidity, perioperative data, length of stay, re-interventions and inpatient readmission. This group of patients was compared with an historic control group of 44 PD patients with a standard postoperative management. RESULTS: A total of 85 pancreatoduodenectomies were analyzed (41 patients in the ERAS group, and 44 patients in the control group. General mortality was 2.4% (2 patients) belonging to the control group. There were no statistical differences in mortality, length of stay in intensive care, reoperationss, and readmissions. ERAS group had a lower morbidity rate than the control group (32 vs. 48%; P=.072), as well as a lower length of stay (14.2 vs. 18.7 days). All the key ERAS proposed elements were achieved. CONCLUSIONS: ERAS programs may be implemented safely in pancreaticoduodenectomy. They may reduce the length of stay, unifying perioperative care and diminishing clinical variability and hospital costs.
BACKGROUND: Enhanced recovery after surgery (ERAS) has demonstrated in colorectal surgery a reduction in morbidity and length of stay without compromising security. Experience with ERAS programs in pancreatoduodenectomy (PD) is still limited. The aims of this study were first to evaluate the applicability of an ERAS program for PDpatients in our hospital, and second to analyze the postoperative results. METHODS: A retrospective study using a prospectively maintained database identified 41 consecutive PD included in an ERAS program. Key elements studied were early removal of tubes and drainages, early oral feeding and early mobilization. Variables studied were mortality, morbidity, perioperative data, length of stay, re-interventions and inpatient readmission. This group of patients was compared with an historic control group of 44 PDpatients with a standard postoperative management. RESULTS: A total of 85 pancreatoduodenectomies were analyzed (41 patients in the ERAS group, and 44 patients in the control group. General mortality was 2.4% (2 patients) belonging to the control group. There were no statistical differences in mortality, length of stay in intensive care, reoperationss, and readmissions. ERAS group had a lower morbidity rate than the control group (32 vs. 48%; P=.072), as well as a lower length of stay (14.2 vs. 18.7 days). All the key ERAS proposed elements were achieved. CONCLUSIONS: ERAS programs may be implemented safely in pancreaticoduodenectomy. They may reduce the length of stay, unifying perioperative care and diminishing clinical variability and hospital costs.
Authors: Junjie Xiong; Peter Szatmary; Wei Huang; Daniel de la Iglesia-Garcia; Quentin M Nunes; Qing Xia; Weiming Hu; Robert Sutton; Xubao Liu; Michael G Raraty Journal: Medicine (Baltimore) Date: 2016-05 Impact factor: 1.889
Authors: Daphne C R van Vliet; Eva van der Meij; Esther V A Bouwsma; Antonie Vonk Noordegraaf; Baukje van den Heuvel; Wilhelmus J H J Meijerink; W Marchien van Baal; Judith A F Huirne; Johannes R Anema Journal: Surg Endosc Date: 2016-05-02 Impact factor: 4.584