Vandana Agarwal1, Martin Jose Thomas2, Riddhi Joshi3, Vikram Chaudhari4, Manish Bhandare4, Abhishek Mitra5, Ashwin deSouza4, Reshma Ambulkar3, Shailesh V Shrikhande4. 1. Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, HBNI, Dr Ernest Borges Marg, Parel, Mumbai, 400012, India. vandanachaukar@hotmail.com. 2. Westmead Hospital Sydney, Sydney, NSW, 2145, Australia. 3. Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, HBNI, Dr Ernest Borges Marg, Parel, Mumbai, 400012, India. 4. Department of Gastrointestinal Surgery, Tata Memorial Centre, HBNI, Dr Ernest Borges Marg, Parel, Mumbai, 400012, India. 5. National Cancer Institute, Nagpur, Maharashtra, India.
Abstract
BACKGROUND: Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery. METHODS: Prospective study conducted from February 2014 to December 2016, following elective pancreatic cancer surgery. Team was educated prior to implementation of ERAS. Patients were followed up until 30 days postoperatively or discharge. Data was recorded regarding the compliance with the protocol, functional GI recovery, mobilisation, and postoperative morbidity and mortality. RESULTS: A total of 394 patients underwent surgery. Compliance with ER elements implemented was 84% (23-100%). Compliance > 80% with ER elements was observed in 278 patients (70.5%) and < 80% in 116 patients (29.5%). Patients with > 80% compliance have significantly lower major complications (28.7 vs. 44%, p = 0.001), mortality (2.1 vs. 6.8%, p = 0.021), and postoperative stay (11 (5-78) days vs. 15 (4-61) days, p < 0.001). CONCLUSION: ER programme is feasible and safe in resource and infrastructure limited lower middle-income country. Improved compliance was associated with reduced major complications, mortality, and shorter stay in patients undergoing pancreatic cancer surgery in high-volume centre. TRIAL REGISTRATION: CTRI/2015/01/005393 ( www.ctri.nic.in ).
BACKGROUND: Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery. METHODS: Prospective study conducted from February 2014 to December 2016, following elective pancreatic cancer surgery. Team was educated prior to implementation of ERAS. Patients were followed up until 30 days postoperatively or discharge. Data was recorded regarding the compliance with the protocol, functional GI recovery, mobilisation, and postoperative morbidity and mortality. RESULTS: A total of 394 patients underwent surgery. Compliance with ER elements implemented was 84% (23-100%). Compliance > 80% with ER elements was observed in 278 patients (70.5%) and < 80% in 116 patients (29.5%). Patients with > 80% compliance have significantly lower major complications (28.7 vs. 44%, p = 0.001), mortality (2.1 vs. 6.8%, p = 0.021), and postoperative stay (11 (5-78) days vs. 15 (4-61) days, p < 0.001). CONCLUSION: ER programme is feasible and safe in resource and infrastructure limited lower middle-income country. Improved compliance was associated with reduced major complications, mortality, and shorter stay in patients undergoing pancreatic cancer surgery in high-volume centre. TRIAL REGISTRATION: CTRI/2015/01/005393 ( www.ctri.nic.in ).
Entities:
Keywords:
Enhanced recovery; Pancreatic cancer resections
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