Nicolò Pecorelli1, Giovanni Capretti1, Gianpaolo Balzano1, Renato Castoldi1, Marianna Maspero2, Luigi Beretta3, Marco Braga4. 1. Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Vita-Salute University, San Raffaele Hospital, Milan, Italy. 2. Department of Surgery, Vita-Salute University, San Raffaele Hospital, Milan, Italy. 3. Department of Anesthesiology, Vita-Salute University, San Raffaele Hospital, Milan, Italy. 4. Department of Surgery, Vita-Salute University, San Raffaele Hospital, Milan, Italy. Electronic address: braga.marco@hsr.it.
Abstract
BACKGROUND: Enhanced recovery (ER) pathways have improved outcomes across multiple surgical specialties, but reports concerning their application in distal pancreatectomy (DP) are lacking. The aim of this study was to assess compliance with an ER protocol and its impact on short-term outcomes in patients undergoing DP. METHODS: Prospectively collected data were reviewed. One hundred consecutive patients undergoing DP were treated within an ER pathway comprising 18 care elements. Each patient was matched 1:1 with a patient treated with usual perioperative care. Match criteria were age, BMI, ASA score, lesion site, and type of disease. RESULTS: Adherence to ER items ranged from 15% for intraoperative restrictive fluids to 100% for intraoperative warming, antibiotic and anti-thrombotic prophylaxis. Patients in ER group experienced earlier recovery of gastrointestinal function (2 vs. 3 days, p < 0.001), oral intake (2 vs. 4 days, p < 0.001), and suspension of intravenous infusions (3 vs. 5 days, p < 0.001). Overall morbidity was similar in the two groups (72% vs. 78%). Length of hospital stay (LOS) was reduced in ER patients without postoperative complications (6.7 ± 1.2 vs. 7.6 ± 1.6 days, p = 0.041). CONCLUSIONS: An ER pathway for DP yielded an earlier postoperative recovery and shortened LOS in uneventful patients. Postoperative morbidity and readmissions were similar in both groups.
BACKGROUND: Enhanced recovery (ER) pathways have improved outcomes across multiple surgical specialties, but reports concerning their application in distal pancreatectomy (DP) are lacking. The aim of this study was to assess compliance with an ER protocol and its impact on short-term outcomes in patients undergoing DP. METHODS: Prospectively collected data were reviewed. One hundred consecutive patients undergoing DP were treated within an ER pathway comprising 18 care elements. Each patient was matched 1:1 with a patient treated with usual perioperative care. Match criteria were age, BMI, ASA score, lesion site, and type of disease. RESULTS: Adherence to ER items ranged from 15% for intraoperative restrictive fluids to 100% for intraoperative warming, antibiotic and anti-thrombotic prophylaxis. Patients in ER group experienced earlier recovery of gastrointestinal function (2 vs. 3 days, p < 0.001), oral intake (2 vs. 4 days, p < 0.001), and suspension of intravenous infusions (3 vs. 5 days, p < 0.001). Overall morbidity was similar in the two groups (72% vs. 78%). Length of hospital stay (LOS) was reduced in ER patients without postoperative complications (6.7 ± 1.2 vs. 7.6 ± 1.6 days, p = 0.041). CONCLUSIONS: An ER pathway for DP yielded an earlier postoperative recovery and shortened LOS in uneventful patients. Postoperative morbidity and readmissions were similar in both groups.
Authors: Patrick Téoule; Laura Römling; Matthias Schwarzbach; Emrullah Birgin; Felix Rückert; Torsten J Wilhelm; Marco Niedergethmann; Stefan Post; Nuh N Rahbari; Christoph Reißfelder; Ulrich Ronellenfitsch Journal: Ther Clin Risk Manag Date: 2019-10-01 Impact factor: 2.423
Authors: Yang Cao; Hui-Yun Gu; Zhen-Dong Huang; Ya-Peng Wu; Qiong Zhang; Jie Luo; Chao Zhang; Yan Fu Journal: Front Oncol Date: 2019-07-30 Impact factor: 6.244