Enhanced Recovery After Surgery Program in Patients Undergoing Pancreaticoduodenectomy

Xiong, Junjie; Szatmary, Peter; Huang, Wei; Iglesia‐García, Daniel de la; Nunes, Quentin; Xia, Qing; Hu, Weiming; Sutton, Robert; Liu, Xuedong; Raraty, Michael

doi:10.1097/md.0000000000003497

Cited by 122 publications

(73 citation statements)

References 46 publications

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“…However, indications have rapidly extended to other specialties in gastrointestinal (bariatric, pancreatic, gastric, esophageal), orthopedic, thoracic, urologic, gynecological, and cardiovascular surgery. [ 9 – 15 ]…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery program versus traditional care after hepatectomy

Chen²,

Z³

et al. 2017

Medicine

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To assess the safety and efficacy of enhanced recovery after surgery (ERAS) as compared with the traditional care in patients undergoing liver surgery and optimization of enhanced recovery programs.Literature, until August 2016, was searched to identify the comparative studies evaluating preoperative hospital stay time, complications, and C-reactive protein (CRP). Pooled odds ratios (OR) or weighted mean differences (WMDs) were calculated with either the fixed or random effect model.These studies included a total of 524 patients: 254 treated with ERAS and 270 with traditional care. The postoperative recovery time and length of hospital stay were significantly better than the control group (WMD −2.72; 95% confidence interval [CI] −3.86 to −1.57; WMD −2.67; 95% CI −3.68 to −1.65, respectively). The overall complications, grade I, and Grand II–V complications were significantly favorable to the ERAS group (OR, 0.45 [95% CI, 0.30–0.67]; OR, 0.55 [95% CI, 0.31–0.98]; OR, 0.49 [95% CI, 0.32–0.76], respectively). The concentration of CRP in the control group was significantly higher than that in the ERAS group on postoperative day 5 (WMD −21.68; 95% CI −29.30 to −14.05). Time to first flatus (WMD −0.93; 95% CI −1.41 to −0.46) was significantly shortened in the ERAS group.The evidence indicates that ERAS following liver surgery is safe, effective, and feasible. Therefore, further are essential for optimizing the ERAS protocols.

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Section: Introductionmentioning

confidence: 99%

Enhanced recovery program versus traditional care after hepatectomy

Chen²,

Z³

et al. 2017

Medicine

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“…In a subanalysis, postoperative pancreatic fistula rates (POPF) were not significantly reduced but the rate of delayed gastric emptying (DGE) was shown to be lower in the ERAS group (11%) versus conventional care (18%). Readmissions and mortality rates were not different between ERAS and conventional care …”

Section: Eras Outcomes In Hpbmentioning

confidence: 84%

“…A recent meta‐analysis pooled the data of 2719 patients in Western countries and found a significant reduction in length of stay of approximately 4 days after PD. In the same meta‐analysis, postoperative morbidity was reduced in ERAS (46%) versus conventional care (57%) . Still, the overall complication rates after pancreatic surgery remain high.…”

Section: Eras Outcomes In Hpbmentioning

confidence: 94%

ERAS: Improving outcome in the cachectic HPB patient

Dijk

Woerden

Cakir

et al. 2017

Journal of Surgical Oncology

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The enhanced recovery after surgery (ERAS) program has reduced postoperative morbidity and duration of hospital stay but not mortality in patients undergoing hepatopancreatobiliary (HPB) surgery. Many HPB patients suffer from cancer cachexia, a syndrome of severe weight and muscle loss. This may affect outcomes of HPB surgery even within an ERAS program. A tailored ERAS approach may be essential in further improving outcome in this vulnerable patient category.

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“…1,2 Similar benefits of ERAS pathways have been shown for other surgical procedures, including liver resection and pancreaticoduodenectomy. [3][4][5] Enhanced recovery after surgery pathways may confer other benefits, such as improvements in the quality of recovery and patient satisfaction. In a study that compared ERAS and conventional management in patients undergoing open colon surgery, ERAS patients had faster rehabilitation, decreased hospital LOS, and better shortterm quality of life (physical, emotional, cognitive, and social functioning).…”

Section: Adult Evidencementioning

confidence: 99%