Enhanced recovery pathway after open pancreaticoduodenectomy reduces postoperative length of hospital stay without reducing composite length of stay

Takchi, Rony; Cos, H.; Williams, Gerhild Scholz; Woolsey, Cheryl A.; Hammill, Chet W.; Fields, Ryan C.; Strasberg, Steven M.; Hawkins, William G.; Sanford, Dominic E.

doi:10.1016/j.hpb.2021.05.014

Cited by 3 publications

(2 citation statements)

References 41 publications

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“…47 Similarly, unplanned readmission is disappointing for patients; an extra two or three days in the hospital is less of a burden than being discharged and returning to the hospital for the same time. 48 Short PLOS and infrequent readmissions are, therefore, the desired outcomes, can be measured objectively and should be the primary indicators for grading postoperative complications.…”

Section: Construct Validity-outcome Measuresmentioning

confidence: 99%

“…Takchi and colleagues noted that shortened PLOS was associated with increased readmission after pancreaticoduodenal resections. 48 Thus, if the effect on readmission is considered, longer PLOS could be beneficial, and shorter PLOS confounding. Composite length of stay (CLOS), a summation of PLOS and readmission LOS, may be used as an accurate single quality measure addressing this.…”

Section: Construct Validity-outcome Measuresmentioning

confidence: 99%

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Classification of postoperative complications in plastic and reconstructive surgery: a systematic review

Singhal,

Tobin,

Hunter-Smith

et al. 2024

Australas J Plast Surg

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"Introduction: Postoperative complications are an integral aspect of the surgical audit, being a surrogate marker of surgical quality. Despite demonstrated efficacy in most specialties, there is scarce validation of current systems in plastic and reconstructive surgery, let alone a system unique to the specialty. This review aims to establish the efficacy of current systems in plastic and reconstructive surgery and formulate a classification unique to our specialty. Methods: A PUBMED literature search was performed in January 2023 encompassing all available literature. Search terms included ‘classification’, ‘grading’, ‘postoperative complications’ and ‘adverse events’. Further additions through bibliographic linkage generated a total of 363 articles. Results: Twenty-four papers were related to PRS. Sixteen used current systems to describe postoperative complications, whereas eight papers used a system designed uniquely for PRS. The downfall of conventional systems is the simplicity of return to the operating theatre, constituting a single grade in the Clavien-Dindo Classification. Return to theatre has a broad scope for heterogeneity in plastic and reconstructive surgery, particularly in reconstructive patients. A modification of the Clavien-Dindo Classification is proposed. Conclusion: There is limited efficacy of current classification systems for postoperative complications in plastic and reconstructive surgery nor a well-validated system unique to the specialty. A modified system with a detailed emphasis on return to the theatre will be of value to plastic and reconstructive surgery and ideally correlate with important outcomes. This will be validated in a retrospective review of the complication audit from the developing institution."

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Section: Construct Validity-outcome Measuresmentioning

confidence: 99%

Section: Construct Validity-outcome Measuresmentioning

confidence: 99%

Classification of postoperative complications in plastic and reconstructive surgery: a systematic review

Singhal,

Tobin,

Hunter-Smith

et al. 2024

Australas J Plast Surg

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Readmission after pancreaticoduodenectomy: Birmingham score validation

Palen

Garnier²,

Ewald³

et al. 2023

HPB

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The Role of Enhanced Recovery after Surgery in Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis

Liotiri,

Diamantis,

Paraskeva

et al. 2024

Eur Surg Res

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Introduction This study aimed to compare the safety and short-term outcomes of ERAS with standard care for patients undergoing pancreatoduodenectomy (PD) based on literature published following the first publication of ERAS guidelines for PD. Methods Five medical databases were searched for studies that compared ERAS to standard care in adults undergoing PD. Data on postoperative complications, length of hospitalization, readmissions, and time to chemotherapy were analyzed using either a fixed- or random-effects model meta-analysis. Meta-regressions were conducted to investigate the role of operative technique, study origin, and study design. Results Our analysis included 22 studies involving 4043 patients. ERAS was associated with fewer complications (RR: 0.83; 0.75 to 0.91), particularly Clavien-Dindo (CD) grade 1 and 2 complications (RR: 0.82; 0.72 to 0.92), delayed gastric emptying (RR: 0.69; 0.52 to 0.93), and postoperative fistula (POPF) (RR: 0.76; 0.66 to 0.89), and a shorter time to chemotherapy (SMD: -0.68; 95% CI: -0.88 to -0.48). ERAS did not affect the risk for CD grade 3 and 4 complications (RR: 1.00; 0.72 to 1.38), post-pancreatectomy hemorrhage (RR: 0.88; 0.67 to 1.14), length of stay (SMD: -0.56; 95% CI: -1.12 to 0.01), readmission (RR: 1.01; 0.84 to 1.21), and mortality (RR: 0.81; 0.54 to 1.22). The continent of origin was an effect moderator in the role of ERAS in CD grade 1 and 2 complications (p= 0.047) and POPF (p=0.02). Conclusion Implementing ERAS principles in PD improves surgical outcomes without compromising safety. ERAS may also accelerate time to chemotherapy, an essential issue for future research.

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Enhanced recovery pathway after open pancreaticoduodenectomy reduces postoperative length of hospital stay without reducing composite length of stay

Cited by 3 publications

References 41 publications

Classification of postoperative complications in plastic and reconstructive surgery: a systematic review

Classification of postoperative complications in plastic and reconstructive surgery: a systematic review

Readmission after pancreaticoduodenectomy: Birmingham score validation

The Role of Enhanced Recovery after Surgery in Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis

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