TY - JOUR
T1 - Enhanced recovery pathway in patients undergoing distal pancreatectomy: A case-matched study
AU - Pecorelli, N
AU - Capretti, Giovanni
AU - Balzano, G
AU - Castoldi, R
AU - Maspero, Marianna
AU - Beretta, L
AU - Braga, M
PY - 2017
Y1 - 2017
N2 - Background: Enhanced recovery (ER) pathways have improved outcomes across multiple surgical specialties, but reports concerning their application in distal pancreatectomy (DP) are lacking. The aim of this study was to assess compliance with an ER protocol and its impact on short-term outcomes in patients undergoing DP. Methods: Prospectively collected data were reviewed. One hundred consecutive patients undergoing DP were treated within an ER pathway comprising 18 care elements. Each patient was matched 1:1 with a patient treated with usual perioperative care. Match criteria were age, BMI, ASA score, lesion site, and type of disease. Results: Adherence to ER items ranged from 15% for intraoperative restrictive fluids to 100% for intraoperative warming, antibiotic and anti-thrombotic prophylaxis. Patients in ER group experienced earlier recovery of gastrointestinal function (2 vs. 3 days, p <0.001), oral intake (2 vs. 4 days, p <0.001), and suspension of intravenous infusions (3 vs. 5 days, p <0.001). Overall morbidity was similar in the two groups (72% vs. 78%). Length of hospital stay (LOS) was reduced in ER patients without postoperative complications (6.7 ± 1.2 vs. 7.6 ± 1.6 days, p = 0.041). Conclusions: 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. © 2016 International Hepato-Pancreato-Biliary Association Inc.
AB - Background: Enhanced recovery (ER) pathways have improved outcomes across multiple surgical specialties, but reports concerning their application in distal pancreatectomy (DP) are lacking. The aim of this study was to assess compliance with an ER protocol and its impact on short-term outcomes in patients undergoing DP. Methods: Prospectively collected data were reviewed. One hundred consecutive patients undergoing DP were treated within an ER pathway comprising 18 care elements. Each patient was matched 1:1 with a patient treated with usual perioperative care. Match criteria were age, BMI, ASA score, lesion site, and type of disease. Results: Adherence to ER items ranged from 15% for intraoperative restrictive fluids to 100% for intraoperative warming, antibiotic and anti-thrombotic prophylaxis. Patients in ER group experienced earlier recovery of gastrointestinal function (2 vs. 3 days, p <0.001), oral intake (2 vs. 4 days, p <0.001), and suspension of intravenous infusions (3 vs. 5 days, p <0.001). Overall morbidity was similar in the two groups (72% vs. 78%). Length of hospital stay (LOS) was reduced in ER patients without postoperative complications (6.7 ± 1.2 vs. 7.6 ± 1.6 days, p = 0.041). Conclusions: 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. © 2016 International Hepato-Pancreato-Biliary Association Inc.
U2 - 10.1016/j.hpb.2016.10.014
DO - 10.1016/j.hpb.2016.10.014
M3 - Article
VL - 19
SP - 270
EP - 278
JO - HPB
JF - HPB
SN - 1365-182X
IS - 3
ER -