Enhanced recovery pathway in patients undergoing distal pancreatectomy: a case-matched study

Pecorelli, Nicolò; Capretti, Giovanni; Balzano, Gianpaolo; Castoldi, R.; Maspero, Marianna; Beretta, Luigi; Braga, Marco

doi:10.1016/j.hpb.2016.10.014

Cited by 20 publications

(13 citation statements)

References 48 publications

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“…The characteristics of the 19 included articles, which comprised 7 cohort studies (8, 23–28) and 12 case-control studies (7, 29–39), are shown in Table 1, which totally contains 3387 patients. Thirteen studies (8, 23, 26, 28–34, 37–39) included patients undergoing PD, one study (35) included patients undergoing distal pancreatectomy (DP), one study (25) included patients undergoing proximal pancreatic resection, one study (36) included patients undergoing laparoscopic pancreatoduodenectomy (LDP), and three studies (7, 24, 27) included patients undergoing two forms of pancreatectomy.…”

Section: Resultsmentioning

confidence: 99%

Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study

Cao

Huang

et al. 2019

Front. Oncol.

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Purpose: To assess the impact of enhanced recovery after surgery (ERAS) protocols in pancreaticoduodenectomy. Methods: Four databases were searched for studies describing ERAS program in patients undergoing pancreatic surgery published up to May 01, 2018. Primary outcomes were mortality, readmission, reoperation and postoperative complications. Secondary outcomes were the length of stay and cost. Results: A total of 19 studies met inclusion and exclusion criteria and included 3,387 patients. Meta-analysis showed a decrease in pancreatic fistula (OR = 0.79, 95% CI: 0.67 to 0.95; I 2 = 0%), infection (OR = 0.63, 95% CI: 0.50 to 0.78; I 2 = 0%), especially incision infection (OR = 0.62, 95% CI: 0.42 to 0.91; I 2 = 0%), and pulmonary infection (OR = 0.28, 95% CI: 0.12 to 0.66; I 2 = 0%). Length-of-stay (MD: −3.89 days, 95% CI: −4.98 to −2.81; I 2 = 78%) and cost were also significantly reduced. There was no significant increase in mortality, readmission, reoperation, or delayed gastric emptying. Conclusion: This analysis revealed that using ERAS protocols in pancreatic resections may help decrease the incidence of pancreatic fistula and infections. Furthermore, ERAS also reduces length of stay and cost of care. This study provides evidence for the benefit of ERAS protocols.

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Section: Resultsmentioning

confidence: 99%

Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study

Cao

Huang

et al. 2019

Front. Oncol.

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“…However, rates of pancreatic fistulae and readmissions were similar compared to non‐ERAS pathway patients 7 . Similarly, Pecorelli et al 5 found ERAS pathway patients to be associated with earlier recovery of gastrointestinal function and shorter length of stay, but postoperative morbidity remained similar between ERAS and non‐ERAS groups.…”

Section: Discussionmentioning

confidence: 86%

“…While an inherent objective of implementing perioperative pathways is reducing variation in care, adherence to pathways is arguably an equally valuable aspect in optimizing patient care. In fact, Pecorelli et al 5 reported that adherence to items in their ERAS pathway ranged from 15% to 100%. An assessment of colorectal ERAS pathway adherence among 12 hospitals in four European countries revealed that adherence to pathway interventions ranged from 6% to 95% 4 .…”

Section: Discussionmentioning

confidence: 99%

“…By standardizing perioperative practices, ERAS pathways reduce unnecessary variation in perioperative care. Heterogeneity, or variation, in care has been demonstrated both within and among institutions in many clinical settings 4,5 . Unnecessary variation in care introduces inefficiencies in healthcare delivery, high cost, and worse patient outcomes 6 …”

Section: Introductionmentioning

confidence: 99%

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Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways

Eng

Blakely

Lafaro

et al. 2020

Journal of Surgical Oncology

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Background Variations in care have been demonstrated both within and among institutions in many clinical settings. By standardizing perioperative practices, Enhanced Recovery After Surgery (ERAS) pathways reduce variation in perioperative care. We sought to characterize the variation in cytoreductive surgery (CRS)/heated intraperitoneal chemotherapy (HIPEC) perioperative practices among experienced US medical centers. Methods Data from the US HIPEC Collaborative represents a retrospective multi‐institutional cohort study of CRS and CRS/HIPEC procedures performed from 12 major academic institutions. Patient characteristics and perioperative practices were reported and compared. Institutional variation was analyzed using hierarchical mixed‐effects linear (continuous outcomes) or logistic (binary outcomes) regression models. Results A total of 2372 operations were included. CRS/HIPEC was performed most commonly for appendiceal histologies (64.2%). The rate of complications (overall 56.3%, range: 31.8‐70.9) and readmissions (overall 20.6%, range: 8.9‐33.3) varied by institution (P < .001). Institution‐level variation in perioperative practice patterns existed among measured ERAS pathway process/outcomes (P < .001). The percentages of variation with each process/outcome measure attributable solely to institutional practices ranged from 0.6% to 66.6%. Conclusions Significant variation exists in the perioperative care of patients undergoing CRS/HIPEC at major US academic institutions. These findings provide a strong rationale for the investigation of best practices in CRS/HIPEC patients.

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“…Vollmer et al proposed that improved process management can mitigate the impact of preoperative risk and effectively deliver quality advances, despite traditional outcomes that may already meet or exceed benchmark outcomes for a given major surgical procedure . Implementation of a clinical pathway as a tool for introducing a well‐established process of care has been reported to be associated favorably with short‐term outcomes after DP, including length of hospital stay in single institutional studies …”

Section: Discussionmentioning

confidence: 99%

Clinical impact of developing better practices at the institutional level on surgical outcomes after distal pancreatectomy in 1515 patients: Domestic audit of the Japanese Society of Pancreatic Surgery

Satoi

Yamamoto

Motoi

et al. 2018

Annals of Gastroent Surgery

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Background and AimInstitutional standardization in the perioperative management of distal pancreatectomy (DP) has not been evaluated in a multicenter setting. The aim of the present study was to assess the influence of institutional standardization on the development of postoperative complications after DP.MethodsData were collected from 1515 patients who underwent DP in 2006, 2010, and 2014 at 53 institutions in Japan. A standardized institution (SI) was defined as one that implemented ≥6 of 11 quality initiatives according to departmental policy. There were 541 patients in the SI group and 974 in the non‐SI group. Clinical parameters were compared between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed‐effects model.ResultsProportion of patients who underwent DP in SI increased from 16.5% in 2006 to 46.4% in 2014. The SI group experienced an improved process of care and a lower frequency of severe complications vs the non‐SI group (grade III/IV Clavien‐Dindo; 22% vs 29%, respectively, clinically relevant postoperative pancreatic fistula; 22% vs 31%, respectively, P < .05 for both). Duration of in‐hospital stay in the SI group was significantly shorter than that in the non‐SI group (16 [5‐183] vs 20 postoperative days [5‐204], respectively; P = .002). Multivariate analysis with a mixed‐effects model showed that soft pancreas, late drain removal, excess blood loss and long surgical time were risk factors for post‐DP complications (P < .05). Pancreatic texture, drain management and surgical factors, but not standardization of care, were associated with a lower incidence of post‐DP complications.

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Enhanced recovery pathway in patients undergoing distal pancreatectomy: a case-matched study

Abstract: 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.

Cited by 20 publications

References 48 publications

Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study

Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study

Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways

Clinical impact of developing better practices at the institutional level on surgical outcomes after distal pancreatectomy in 1515 patients: Domestic audit of the Japanese Society of Pancreatic Surgery

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