Enhancing the cost-effectiveness of surgical care in pancreatic cancer: a systematic review and cost meta-analysis with trial sequential analysis

Karunakaran, Monish; Jonnada, Pavan Kumar; Chandrashekhar, Sagar H; Vinayachandran, Gopika; Kaambwa, Billingsley; Barreto, Savio George

doi:10.1016/j.hpb.2021.11.004

Cited by 7 publications

(4 citation statements)

References 58 publications

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Section: Eras and Surgical Oncologymentioning

confidence: 99%

“…The use of ERAS-based clinical pathways for patients who had pancreatoduodenectomy due to pancreatic cancer has been shown to be effective for both increased patient care and reduced hospital costs according to the meta-analysis by Karunakaran et al [ 32 ]. The authors recorded a significant decrease in hospital stays, complications, and overall hospital costs through the ERAS arm of care compared with standard care [ 32 ]. The respective benefits have also been seen in patients with gastric cancer who underwent surgery with preoperative education, early rehabilitation with mobilization, and first postoperative day oral feeding [ 33 ].…”

Section: Eras and Surgical Oncologymentioning

confidence: 99%

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Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy

Prodromidou

Koulakmanidis

Haidopoulos

et al. 2022

Cancers

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The outbreak of the SARS-CoV-2 (COVID-19) pandemic has transformed the provision of medical services for both patients that receive care for COVID-19 and for those that need care either for benign diseases, including obesity, or for malignancies, such as gynecological cancer. In this perspective article, we focus on the association among three major worldwide health issues and how ERAS protocols can potentially provide optimal management of patients with obesity and malignancy during the COVID-19 pandemic, with special attention to patients who required surgery for gynecologic oncology. A thorough search of the literature on the respective topics was performed. Patients with malignancy and obesity presented with increased vulnerability to COVID-19 infection. However, the management of their disease should not be withheld. Protective measures should be established to reduce exposure of patients with oncological diseases to SARS-CoV-2 while simultaneously enabling their access to vaccination. Since ERAS protocols have proved to be efficient in many surgical fields, including gynecologic oncology, general surgery, and orthopedics, we strongly believe that ERAS protocols may play a significant role in this effort. The end of the COVID-19 pandemic cannot be accurately predicted. Nevertheless, we have to ensure the appropriate and efficient management of certain groups of patients.

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Section: Eras and Surgical Oncologymentioning

confidence: 99%

Section: Eras and Surgical Oncologymentioning

confidence: 99%

Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy

Prodromidou

Koulakmanidis

Haidopoulos

et al. 2022

Cancers

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“…Despite the availability of evidence that ERAS ® pathways for PD reduce post-operative length of stay [ 6 ], overall morbidity [ 7 ] and costs [ 8 ] without an increase in major complications, readmissions, reoperations, or mortality[ 6 ], its uptake has been slow in pancreatic surgery and has been dogged by low compliance even in centers that have adopted the pathways to enhance recovery [ 9 ]. While it may be surmised that availability of resources, or lack thereof, and the reluctance to change individual practice guided by dogmatism that focuses on the lack of sufficient evidence [ 10 ] of the benefits of ERAS ® , may be some of the reasons, the fact remains that global perceptions of ERAS ® in PD have not been systematically explored.…”

Section: Introductionmentioning

confidence: 99%

Global Perceptions on ERAS^® in Pancreatoduodenectomy

Karunakaran,

Roulin,

Ullah

et al. 2023

World j. surg.

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Background Uptake of ERAS® pathways for pancreatic surgery have been slow and impacted by low compliance. Objective To explore global awareness, perceptions and practice of ERAS® peri-pancreatoduodenectomy (PD). Methods A structured, web-based survey (EPSILON) was administered through the ERAS® society and IHPBA membership. Results The 140 respondents included predominantly males (86.4%), from Europe (45%), practicing surgery (95%) at academic/teaching hospitals (63.6%) over a period of 10–20 years (38.6%). Most respondents identified themselves as general surgeons (68.6%) with 40.7% reporting an annual PD volume of 20–50 cases, practicing post-PD clinical pathways (37.9%), with 31.4% of respondents auditing their outcomes annually. Reduced medical complications, cost and hospital length of stay, and improved patient satisfaction were perceived benefits of compliance to enhancing-recovery. Multidisciplinary co-ordination was considered the most important factor in the implementation and sustainability of peri-PD ERAS® pathways, while reluctance to change among health care practitioners, difficulties in data collection and audit, lack of administrative support, and recruitment of an ERAS® dedicated nurse were reported to be important barriers. Conclusions The EPSILON survey highlighted global clinician perceptions regarding the benefits of compliance to peri-PD ERAS®, the importance of individual components, perceived facilitators and barriers, to the implementation and sustainability of these pathways.

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“…Perioperative nutrition is defined here as the implementation of nutrition interventions before and after the surgical procedure. Benefits for patients include not only reduction of postoperative complications and LOS, but also a sharp decrease in the cost of surgical procedures [6,7]. This review aims to provide an update of the recent evidence on the potential of perioperative nutritional interventions to benefit adult patients undergoing head and neck surgery of the digestive tract along with digestive surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Extending the benefit of nutrition intervention beyond the operative setting

Nogueira

Dock-Nascimento

Aguilar-Nascimento

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewTo provide an update of the recent evidence on the potential of perioperative nutritional interventions to benefit adult patients undergoing head and neck and digestive procedures. Recent findingsPerioperative nutrition within multimodal prehabilitation programs improve postoperative outcomes. Perioperative fasting time can be reduced with beverages containing carbohydrate alone or blended with a nitrogenous source such as whey protein; this approach seems to be safe and improve outcome. The choice of protein-containing formula, as well as diet composition to be recommended early during the postoperative refeeding, can be optimized to reduce complications. Sarcopenia is an important risk factor for surgical patients, as such, prehabilitation along with preoperative nutrition is strongly advised. Perioperative supplementation with b-hydroxy b-methylbutyrate to mitigate sarcopenia requires further investigation. Although perioperative nutritional interventions reduce healthcare costs, recent data suggest it has been scarcely prescribed.

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Enhancing the cost-effectiveness of surgical care in pancreatic cancer: a systematic review and cost meta-analysis with trial sequential analysis

Cited by 7 publications

References 58 publications

Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy

Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy

Global Perceptions on ERAS^® in Pancreatoduodenectomy

Extending the benefit of nutrition intervention beyond the operative setting

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Enhancing the cost-effectiveness of surgical care in pancreatic cancer: a systematic review and cost meta-analysis with trial sequential analysis

Cited by 7 publications

References 58 publications

Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy

Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy

Global Perceptions on ERAS® in Pancreatoduodenectomy

Extending the benefit of nutrition intervention beyond the operative setting

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Global Perceptions on ERAS^® in Pancreatoduodenectomy