Katherine A Morgan1, William P Lancaster2, Megan L Walters2, Stefanie M Owczarski2, Carlee A Clark3, Julie R McSwain3, David B Adams2. 1. Division of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC. Electronic address: morganka@musc.edu. 2. Division of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC. 3. Department of Anesthesia, Medical University of South Carolina, Charleston, SC.
Abstract
BACKGROUND: There is increasing interest in implementing comprehensive perioperative protocols, including preoperative optimization and education, perioperative goal-directed fluid management, and postoperative fast tracking, to enhance recovery after surgery. Data on the outcomes of these protocols in pancreatic surgery, however, are limited. STUDY DESIGN: A retrospective review of a prospectively maintained pancreas surgery database at a single institution from August 2012 to April 2015 was undertaken. An enhanced recovery protocol was initiated in October 2014, and patients were divided into groups according to preprotocol or postprotocol implementation. Preoperative, intraoperative, and postoperative data were tabulated. Statistical analysis was performed with Student's t-test and Fisher's exact tests, as well as equality of variances where appropriate, using SAS System software (SAS Institute). RESULTS: Three hundred and seventy-eight patients (181 men, mean age 54 years, BMI 28 kg/m(2)) underwent elective pancreatic surgery during the study period, 297 patients preprotocol and 81 postprotocol. There were no significant differences in preoperative or intraoperative characteristics. Mean postoperative length of stay was significantly lower in the Enhanced Recovery After Surgery group (7.4 vs 9.2 days; p < 0.0001). Hospital costs were similarly lower in the Enhanced Recovery After Surgery group ($23,307.90 vs $27,387.80; p < 0.0001). Readmission (29% vs 32%) and pancreatic fistula (26% vs 28%) rates were similar between groups. Delayed gastric emptying was lower in the Enhanced Recovery After Surgery group (26% vs 13%; p = 0.03). CONCLUSIONS: Implementation of an enhanced recovery after pancreatic surgery protocol significantly decreased length of stay and hospital cost without increasing readmission or morbidity. Despite patient complexity and the potential need for individualization of care, enhanced recovery protocols can be valuable and effective in high-risk patient populations, including pancreatic surgery patients.
BACKGROUND: There is increasing interest in implementing comprehensive perioperative protocols, including preoperative optimization and education, perioperative goal-directed fluid management, and postoperative fast tracking, to enhance recovery after surgery. Data on the outcomes of these protocols in pancreatic surgery, however, are limited. STUDY DESIGN: A retrospective review of a prospectively maintained pancreas surgery database at a single institution from August 2012 to April 2015 was undertaken. An enhanced recovery protocol was initiated in October 2014, and patients were divided into groups according to preprotocol or postprotocol implementation. Preoperative, intraoperative, and postoperative data were tabulated. Statistical analysis was performed with Student's t-test and Fisher's exact tests, as well as equality of variances where appropriate, using SAS System software (SAS Institute). RESULTS: Three hundred and seventy-eight patients (181 men, mean age 54 years, BMI 28 kg/m(2)) underwent elective pancreatic surgery during the study period, 297 patients preprotocol and 81 postprotocol. There were no significant differences in preoperative or intraoperative characteristics. Mean postoperative length of stay was significantly lower in the Enhanced Recovery After Surgery group (7.4 vs 9.2 days; p < 0.0001). Hospital costs were similarly lower in the Enhanced Recovery After Surgery group ($23,307.90 vs $27,387.80; p < 0.0001). Readmission (29% vs 32%) and pancreatic fistula (26% vs 28%) rates were similar between groups. Delayed gastric emptying was lower in the Enhanced Recovery After Surgery group (26% vs 13%; p = 0.03). CONCLUSIONS: Implementation of an enhanced recovery after pancreatic surgery protocol significantly decreased length of stay and hospital cost without increasing readmission or morbidity. Despite patient complexity and the potential need for individualization of care, enhanced recovery protocols can be valuable and effective in high-risk patient populations, including pancreatic surgery patients.
Authors: Julie R McSwain; Madeline Nykamp; Bethany J Wolf; Jeffrey D McMurray; Christopher A Skorke; Carlee A Clark Journal: Pancreas Date: 2019-02 Impact factor: 3.327
Authors: B Phillips; S Holzmer; L Turco; M Mirzaie; E Mause; A Mause; A Person; S W Leslie; D L Cornell; M Wagner; R Bertellotti; J A Asensio Journal: Eur J Trauma Emerg Surg Date: 2017-07-20 Impact factor: 3.693
Authors: Sephalie Y Patel; Rosemarie E Garcia Getting; Brandon Alford; Karim Hussein; Braydon J Schaible; David Boulware; Jae K Lee; Scott M Gilbert; Julio M Powsang; Wade J Sexton; Philippe E Spiess; Michael A Poch Journal: World J Surg Date: 2018-09 Impact factor: 3.352