Enhanced recovery in the management of mild gallstone pancreatitis: a prospective cohort study

Abstract

PurposeThe aim of this study was to establish enhanced recovery protocols for the management of mild gallstone pancreatitis.MethodsSixty consecutive patients were divided into enhanced recovery and traditional recovery (TR) groups in a randomized observational study. The basic enhanced recovery elements included early laparoscopic cholecystectomy, restrictive endoscopic intervention, and early oral nutrition. The incidence of complications, readmission, length of stay, and total medical cost were analyzed during the hospital course.ResultsThe length of hospital stay and medical cost were significantly lower in the enhanced recovery group in comparison to the TR group: 5.9 days vs. 10.6 days (P < 0.01) and ¥10,023 vs. ¥15,035 (P < 0.01). The complications and readmission rates in the two groups were similar.ConclusionsThe implementation of enhanced recovery protocols is feasible in the management of mild gallstone pancreatitis. The utilization of these protocols can achieve shorter hospital stays and reduced costs, with no increase in either the re-admission or peri-operative complication rates.

Systematic review of outcomes used to evaluate enhanced recovery after surgery

“…A total of 24 studies reported recovery outcomes measured within 30 days after surgery. Only two articles reported recovery outcomes at 60 days after surgery, one study at 90 days, and ten studies did not specify the follow‐up duration. Baseline measures were reported in 21 of the studies.…”

“…Other outcomes reported included cost 26,30,35,36,44,49,50,59 , pathway adherence 34,39,47 and patient satisfaction 25,34,40,42,43,49 . Many studies reported 'outcomes' related to compliance with processes of care, such as time to removal of the urinary drainage catheter and outcomes related to intravenous fluid administration (either total volume infused or time to discontinuation).…”

Evaluation of Prognostic Factors of Severity in Acute Biliary Pancreatitis

“…The population included in this study was exclusively composed of patients with acute biliary pancreatitis, considered in the Mediterranean countries, the most common etiology [ 2 ]. Since the gallstones etiology is the most frequent cause of AP in these countries, and although differences are recognized between the various etiologies of AP, there are few studies aimed at this subtype of patient population [ 25 , 26 ].…”

The optimal timing of laparoscopic cholecystectomy in patients with mild gallstone pancreatitis

“…Moreover, we defined the node with 72 hours as an early group and conducted a meta-analysis of the included literature. The results showed that the early surgery group did not experience increased postoperative complications [12,14–16,18,20–23,25,27–28] (RR = 0.86; 95% CI = 0.56–1.32; P = .49) and conversion to open surgery [12,14–16,18,20–23,25,27] (RR = 0.84; 95% CI = 0.37–1.91; P = .68) compared with delayed surgery.…”