Risk factors for failure of early recovery from pancreatoduodenectomy despite the use of enhanced recovery after surgery protocols and a physical aging score to predict postoperative risks

Kobayashi, Shogo; Segami, Kohei; Hoshino, Hironobu; Nakahara, Kazunari; Katayama, Masafumi; Koizumi, Satoshi; Otsubo, Takehito

doi:10.1002/jhbp.540

Cited by 13 publications

(26 citation statements)

References 40 publications

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“…We determined that patients in the late-discharge group were significantly older and had a higher rate of CDC grade ≥ IIIa than those in the early-discharge group. Previous studies have shown that age and postoperative complications were associated with longer LOS (Xie et al 2013;Chaudhary et al 2015;Kim et al 2017;Kobayashi et al 2018;Pedziwiatr et al 2018;Jiang et al 2019). Our results were also consistent with those of the previous reports.…”

Section: Discussionsupporting

confidence: 93%

“…Our results were also consistent with those of the previous reports. The prolonged postoperative recovery probably reflects the decreased physical fitness and physiological capacity in older patients, as represented by frailty, in comparison with younger patients (Xie et al 2013;Kobayashi et al 2018). Therefore, it is anticipated that a higher rate of complications will occur in the late-discharge group than in the early-discharge group.…”

Section: Discussionmentioning

confidence: 99%

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Role of Early Mobilization on the Clinical Course of Patients who Underwent Pancreaticoduodenectomy: A Retrospective Cohort Study

Fukushima

Adachi

Hanada

et al. 2021

Tohoku J. Exp. Med.

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The length of hospital stay is an important outcome measure in patients who have undergone pancreaticoduodenectomy. Although postoperative complications are known to adversely affect the length of hospital stay (LOS), the influence of early mobilization on LOS has not been clarified yet. This study aimed to examine the impact of the initial ambulation day, which is one of the components of early mobilization, on LOS after pancreaticoduodenectomy. We retrospectively enrolled patients who underwent pancreaticoduodenectomy between January 2013 and December 2017. Postoperative complications were evaluated using the Clavien-Dindo classification (CDC) system. Patients were divided into two groups based on the median LOS (early and late-discharge groups) and compared to determine their characteristics. Multivariate logistic regression analysis was performed with LOS as the dependent variable. Patients in the late-discharge group were significantly older, had an initial ambulation delay, and had higher rates of advanced disease stages and a CDC grade ≥ IIIa than those in the early discharge group. In the multivariate logistic regression analysis, CDC grade ≥ IIIa, initial ambulation day, and age were found to be significant independent factors associated with LOS. Our results demonstrated that not only postoperative complications, but also the initial ambulation day, could affect LOS after pancreaticoduodenectomy, emphasizing the importance of early ambulation for patients who undergo this surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Role of Early Mobilization on the Clinical Course of Patients who Underwent Pancreaticoduodenectomy: A Retrospective Cohort Study

Fukushima

Adachi

Hanada

et al. 2021

Tohoku J. Exp. Med.

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“…Many factors, such as age, nutritional status, and serious comorbidity, can influence patients’ postoperative complication rates and the process of postoperative recovery[ 41 , 42 ]. The patients’ demographic data in the included studies was basically identical, so these influences may be eliminated for the outcomes in this study.…”

Section: Discussionmentioning

confidence: 99%

Impact of enhanced recovery after surgery programs on pancreatic surgery: A meta-analysis

Ji¹,

Zhu²,

Wei³

et al. 2018

WJG

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AIMTo evaluate the impact of enhanced recovery after surgery (ERAS) programs on postoperative complications of pancreatic surgery.METHODSComputer searches were performed in databases (including PubMed, Cochrane Library and Embase) for randomized controlled trials or case-control studies describing ERAS programs in patients undergoing pancreatic surgery published between January 1995 and August 2017. Two researchers independently evaluated the quality of the studies’ extracted data that met the inclusion criteria and performed a meta-analysis using RevMan5.3.5 software. Forest plots, demonstrating the outcomes of the ERAS group vs the control group after pancreatic surgery, and funnel plots were used to evaluate potential publication bias.RESULTSTwenty case-control studies including 3694 patients, published between January 1995 and August 2017, were selected for the meta-analysis. This study included the ERAS group (n = 1886) and the control group (n = 1808), which adopted the traditional perioperative management. Compared to the control group, the ERAS group had lower delayed gastric emptying rates [odds ratio (OR) = 0.58, 95% confidence interval (CI): 0.48-0.72, P < 0.00001], lower postoperative complication rates (OR = 0.57, 95%CI: 0.45-0.72, P < 0.00001), particularly for the mild postoperative complications (Clavien-Dindo I-II) (OR = 0.71, 95%CI: 0.58-0.88, P = 0.002), lower abdominal infection rates (OR = 0.70, 95%CI: 0.54-0.90, P = 0.006), and shorter postoperative length of hospital stay (PLOS) (WMD = -4.45, 95%CI: -5.99 to -2.91, P < 0.00001). However, there were no significant differences in complications, such as, postoperative pancreatic fistulas, moderate to severe complications (Clavien-Dindo III- V), mortality, readmission and unintended reoperation, in both groups.CONCLUSIONThe perioperative implementation of ERAS programs in pancreatic surgery is safe and effective, can decrease postoperative complication rates, and can promote recovery for patients.

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“…Our data suggest the e ciency of ERAS programmes for decreasing postoperative complications and morbidity, which is consistent with a previous RCT on ERAS protocols for OPD 12 . Moreover, a recent retrospective study found that lower pre-albumin level, higher ASA score and longer operative time were independent risk factors for failure of early recovery from OPD and increased complications of ERAS for OPD 10 . Of note, we found that more patients had pulmonary infections in the non-ER group compared with the ER group.…”

Section: Discussionmentioning

confidence: 99%

“…With the increased publication of ERAS guidelines to optimize patient outcomes after more complex and high-risk surgical procedures, there is growing enthusiasm and interest among healthcare professionals for studies on ERAS programmes in patients after open pancreatoduodenectomy (OPD) [8][9][10][11] . Encouragingly, most initial studies have shown the feasibility and safety of ERAS for OPD, such as early discharge 11 , decreased morbidity 12 , and fewer postoperative complications 13 .…”

Section: Introductionmentioning

confidence: 99%

A Clinical Observational Study on the Application of Enhanced Recovery After Laparoscopic Pancreaticoduodenectomy

Che

Li³

et al. 2021

Preprint

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Background: The safety and feasibility of enhanced recovery after surgery (ERAS) for laparoscopic pancreaticoduodenectomy (LPD) are unclear. The aim of this retrospective clinical study was to evaluate the impact of ERAS protocols for LPD.Methods: Between March 2016 and December 2018, a total of 34 consecutive patients with ERAS for LPD were prospectively enrolled and compared with 68 consecutive patients previously treated for non-ERAS after LPD during an equal time frame. The intraoperative and postoperative data were collected and comparatively analyzed. Results: The mean length of postoperative hospital stay (15.8±3.4 and 23.1±5.1 days, P<0.001) and total medical costs (¥14.3±4.8 x104 and ¥15.8±4.9 x104, P=0.017) were reduced significantly in ER group than those in non-ER group. The operation time (462.7±117.0 vs 450.9±109.8 min, P=0.627) and intraoperative blood loss (523.5±270.0 vs 537.5±241.8 mL, P=0.800) were similar in the two groups. The complications of patients with ERAS protocols were not increased (P>0.05). No difference in mortality and readmission rates was found.Conclusions: The ERAS is safe and effective in the perioperative period of LPD. It could effectively reduce the length of postoperative stay and medical costs, and does not increase the incidence of postoperative complications.

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Risk factors for failure of early recovery from pancreatoduodenectomy despite the use of enhanced recovery after surgery protocols and a physical aging score to predict postoperative risks

Abstract: Advanced age, poor nutrition, and serious illnesses can cause ERAS protocol failure. The PA score is effective for predicting postoperative progress.

Cited by 13 publications

References 40 publications

Role of Early Mobilization on the Clinical Course of Patients who Underwent Pancreaticoduodenectomy: A Retrospective Cohort Study

Role of Early Mobilization on the Clinical Course of Patients who Underwent Pancreaticoduodenectomy: A Retrospective Cohort Study

Impact of enhanced recovery after surgery programs on pancreatic surgery: A meta-analysis

A Clinical Observational Study on the Application of Enhanced Recovery After Laparoscopic Pancreaticoduodenectomy

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