Risk-stratified clinical pathways decrease the duration of hospitalization and costs of perioperative care after pancreatectomy

Published on Sep 1, 2018in Surgery3.982
路 DOI :10.1016/J.SURG.2018.04.014
Jason W. Denbo16
Estimated H-index: 16
(UMN: University of Minnesota),
Morgan L. Bruno6
Estimated H-index: 6
(University of Texas MD Anderson Cancer Center)
+ 7 AuthorsMatthew H.G. Katz69
Estimated H-index: 69
(University of Texas MD Anderson Cancer Center)
Sources
Abstract
Abstract Background Postoperative pancreatic fistula is associated with adverse events, increased duration of stay and hospital costs. We developed perioperative care pathways stratified by postoperative pancreatic fistula risk with the aims of minimizing variations in care, improving quality, and decreasing costs. Study Design Three unique risk-stratified pancreatectomy clinical pathways鈥攍ow-risk pancreatoduodenectomy, high-risk pancreatoduodenectomy, and distal pancreatectomy were developed and implemented. Consecutive patients treated after implementation of the risk-stratified pancreatectomy clinical pathways were compared with patients treated immediately prior. Duration of stay, rates of perioperative adverse effects, discharge disposition, and hospital readmission, as well as the associated costs of care, were evaluated. Results The median hospital stay after pancreatectomy decreased from 10 to 6 days after implementation of the risk-stratified pancreatectomy clinical pathways (P Conclusion Implementation of risk-stratified pancreatectomy clinical pathways decreased median stay and cost of index hospitalization after pancreatectomy without unfavorably affecting rates of perioperative adverse events or readmission, or discharge disposition. Outcomes were most favorably improved for low-risk pancreatoduodenectomy and distal pancreatectomy. Additional work is necessary to decrease the rate of postoperative pancreatic fistula, minimize variability, and improve outcomes after high-risk pancreatoduodenectomy.
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References62
Newest
#1Trevor Wood (U of T: University of Toronto)H-Index: 5
#2Mary-Anne Aarts (U of T: University of Toronto)H-Index: 13
Last. Robin S. McLeod (U of T: University of Toronto)H-Index: 15
view all 8 authors...
Background Enhanced Recovery After Surgery (ERAS) guidelines have been widely promoted and supported largely due to several studies showing decreased post-operative complications and length of stay. The objective of this study was to review the emergency room (ER) visits and readmission rates and reasons for both in patients who were part of the Implementation of an Enhanced Recovery After Surgery (iERAS) program for colorectal surgery.
Source
#1Anthony Visioni (Roswell Park Cancer Institute)H-Index: 3
#2Rupen Shah (Roswell Park Cancer Institute)H-Index: 10
Last. Steven J. Nurkin (Roswell Park Cancer Institute)H-Index: 19
view all 6 authors...
Objective:To evaluate the impact of enhanced recovery after surgery (ERAS) protocols across noncolorectal abdominal surgical procedures.Background:ERAS programs have been studied extensively in colorectal surgery and adopted at many centers. Several studies testing such protocols have shown promisin
Source
#1Ruben van Zelm (Katholieke Universiteit Leuven)H-Index: 10
#2Ellen Coeckelberghs (Katholieke Universiteit Leuven)H-Index: 11
Last. Kris Vanhaecht (Katholieke Universiteit Leuven)H-Index: 34
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Purpose Surgical care for patients with colorectal cancer has become increasingly standardized. The Enhanced Recovery After Surgery (ERAS) protocol is a widely accepted structured care method to improve postoperative outcomes of patients after surgery. Despite growing evidence of effectiveness, adherence to the protocol remains challenging in practice. This study was designed to assess the adherence rate in daily practice and examine the relationship between the importance of interventions and a...
Source
#1Dimitrios Xourafas (Brigham and Women's Hospital)H-Index: 8
#2Stanley W. Ashley (Brigham and Women's Hospital)H-Index: 96
Last. Thomas E. Clancy (Brigham and Women's Hospital)H-Index: 33
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Background Robotic surgery is gaining acceptance for distal pancreatectomy (DP). Nevertheless, no multi-institutional data exist to demonstrate the ideal clinical circumstances for use and the efficacy of the robot compared to the open or laparoscopic techniques, in terms of perioperative outcomes.
Source
#1Micha艂 P臋dziwiatr (Jagiellonian University Medical College)H-Index: 25
#2Piotr Ma艂czak (Jagiellonian University Medical College)H-Index: 17
Last. Andrzej Budzy艅ski (Jagiellonian University Medical College)H-Index: 26
view all 7 authors...
Purpose The purpose of this systematic review was to compare minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) by using meta-analytical techniques.
Source
#1Olga Kantor (U of C: University of Chicago)H-Index: 13
#2Mark S. Talamonti (U of C: University of Chicago)H-Index: 69
Last. Marshall S. Baker (U of C: University of Chicago)H-Index: 18
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Background The Fistula Risk Score (FRS) is a clinical tool developed from single-institutional data using primarily intraoperative factors to characterize the risk of clinically relevant pancreatic fistula (CR-POPF) after pancreaticoduodenectomy. We developed a modified FRS based on objective, nationally accrued data that is more readily determined before resection. Study Design The 2012 NSQIP Pancreatic Demonstration Project (PDP) was used to identify 1,731 pancreaticoduodenectomy resections ov...
Source
#1Nicol貌 Pecorelli (MUHC: McGill University Health Centre)H-Index: 20
#2Olivia Hershorn (MUHC: McGill University Health Centre)H-Index: 2
Last. Liane S. Feldman (MUHC: McGill University Health Centre)H-Index: 66
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Introduction Guidelines recommend incorporation of more than 20 perioperative interventions within an enhanced recovery program (ERP). However, the impact of overall adherence to the pathway and the relative contribution of each intervention are unclear. The aim of this study was to estimate the extent to which adherence to ERP elements is associated with outcomes and identify key ERP elements predicting successful recovery following bowel resection.
Source
#1B氓rd I. R酶sok (Oslo University Hospital)H-Index: 27
#2Thijs de RooijH-Index: 18
Last. Herbert J. ZehH-Index: 90
view all 21 authors...
Abstract Background The first International conference on Minimally Invasive Pancreas Resection was arranged in conjunction with the annual meeting of the International Hepato-Pancreato-Biliary Association (IHPBA), in Sao Paulo, Brazil on April 19th 2016. The presented evidence and outcomes resulting from the session for minimally invasive distal pancreatectomy (MIDP) is summarized and addressed perioperative outcome, the outcome for cancer and patient selection for the procedure. Methods A lite...
Source
#1Joal D. Beane (IU: Indiana University)H-Index: 23
#2Michael G. House (IU: Indiana University)H-Index: 27
Last. Henry A. Pitt (TU: Temple University)H-Index: 61
view all 8 authors...
Abstract Introduction Vascular resection during pancreatoduodenectomy (PD) is being performed more frequently. Our aim was to analyze the outcomes of PD with and without vascular resection in a large, multicenter cohort. Methods Patient data were gathered from 43 institutions as part of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Pancreatectomy Demonstration Project. Over a 14-month period, 1414 patients underwent PD without (82.2%) or with major ve...
Source
#4Jordan M. Cloyd (University of Texas MD Anderson Cancer Center)H-Index: 22
Background In a randomized trial, pasireotide significantly decreased the incidence and severity of postoperative pancreatic fistula (POPF). Subsequent analyses concluded that its routine use is cost-effective. We hypothesized that selective administration of the drug to patients at high risk for POPF would be more cost-effective.
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No accepted benchmarks for open pancreaticoduodenectomy (PD) exist. The study assessed the time to functional recovery after open PD and how this could be affected by the magnitude of midline incision (MI). Prospective snapshot study during 1聽year. Time to functional recovery (TtFR) was assessed for the entire cohort. Further analyses were conducted after excluding patients developing a Clavien-Dindo鈥夆墺鈥2 morbidity and after stratifying for the relative length of MI. The overall median TtFR was 7...
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#1Natalia Paez Arango (University of Texas MD Anderson Cancer Center)H-Index: 3
#2Laura R. Prakash (University of Texas MD Anderson Cancer Center)H-Index: 15
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Delayed gastric emptying (DGE) is a frequent complication after pancreaticoduodenectomy (PD) that impairs recovery and quality of life. The purpose of this study was to assess the impact risk-stratified pancreatectomy clinical pathways (RSPCPs) had on delayed gastric emptying (DGE) and identify factors associated with DGE in a contemporary period. A single-institution, prospective database was queried for consecutive PDs during July 2011鈥揘ovember 2019. Using international definitions, DGE rates ...
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#1Timothy E. Newhook (University of Texas MD Anderson Cancer Center)H-Index: 14
#2Laura R. Prakash (University of Texas MD Anderson Cancer Center)H-Index: 15
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BACKGROUND AND OBJECTIVES The impact of perioperative blood transfusion (PBT) on outcomes for pancreatic ductal adenocarcinoma (PDAC) patients given multimodality therapy (MMT) remains undefined. We sought to evaluate the association of PBT with survival after PDAC resection. METHODS Pancreatectomy patients (July 2011-December 2017) who received MMT were abstracted from a prospective database. Overall survival (OS) was compared by PBT within 30 days, 24鈥塰 (24HR-BT), or 24鈥塰 until 30 days (Postop...
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#1Giampaolo PerriH-Index: 8
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Abstract null null Background null Existing postoperative pancreatic fistula risk scores rely on intraoperative parameters, which limits their value in the preoperative setting. A preoperative predictive model to stratify the risk of developing postoperative pancreatic fistula before pancreatoduodenectomy was built and externally validated. null null null Methods null A regression risk-tree model for preoperative postoperative pancreatic fistula risk stratification was developed in the Verona Un...
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#1Monish Karunakaran (Medanta)H-Index: 2
#2Savio G. Barreto (Flinders University)H-Index: 22
OBJECTIVE This narrative review traces the evolutionary journey of ERAS庐 with emphasis on challenges specific to pancreatic cancer. This article will also attempt to explore the barriers to routine ERAS庐 implementation and offers possible solutions to increasing its uptake and compliance rates. BACKGROUND Enhanced Recovery After Surgery (ERAS庐) represents a paradigm shift in the perioperative management of surgical patients using a multi-modality approach each of which is based on best available...
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#1Th茅ophile Guilbaud (AMU: Aix-Marseille University)H-Index: 6
#2Jonathan Garnier (AMU: Aix-Marseille University)H-Index: 6
Last. Olivier Turrini (AMU: Aix-Marseille University)H-Index: 37
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Abstract null null Background null Several scoring systems predict risks of clinically relevant postoperative pancreatic fistula after pancreatectomy, but none have emerged as the gold standard. This study aimed to evaluate the accuracy of postoperative day 1 drain amylase and serum C-reactive protein levels in predicting clinically relevant postoperative pancreatic fistula compared with intraoperative pancreatic characteristics. null null null Methods null Patients who underwent pancreatectomy ...
Source
#1Cameron E Gaskill (University of Texas MD Anderson Cancer Center)H-Index: 1
#2Jessica E. Maxwell (University of Texas MD Anderson Cancer Center)H-Index: 2
Last. Matthew H.G. Katz (University of Texas MD Anderson Cancer Center)H-Index: 69
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Systemic chemotherapy improves the survival of patients who undergo pancreatectomy, but whether chemotherapy should be delivered before or after surgery remains debated. At The University of Texas MD Anderson Cancer Center, localized pancreatic ductal adenocarcinoma (PDAC) has been preferentially treated with preoperative therapy-a practice supported by a robust history of institutional and national trials. In the following review, we discuss the historical use of perioperative therapy, our expe...
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#1Timothy E. Newhook (University of Texas MD Anderson Cancer Center)H-Index: 14
#2Jose M. Soliz (University of Texas MD Anderson Cancer Center)H-Index: 10
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BACKGROUND Administration of dexamethasone to mitigate postoperative nausea and vomiting has been suggested to improve short- and long-term outcomes after pancreatic ductal adenocarcinoma (PDAC) resection. This study aimed primarily to evaluate these hypotheses in a contemporary patient cohort treated with multimodality therapy. METHODS The clinicopathologic and perioperative characteristics of consecutive resected PDAC patients (July 2011 to October 2018) were analyzed from a prospectively main...
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#1Casey J. Allen (University of Texas MD Anderson Cancer Center)H-Index: 3
#2Jarrod S. Eska (University of Texas MD Anderson Cancer Center)H-Index: 2
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Abstract Background There remains no tool to quantify the total value of comparative processes in health care. Hospital administrative data sets are emerging as valuable sources to evaluate performance. Thus, we use a framework to simultaneously assess multiple domains of value associated with an enhanced recovery initiative using national administrative data. Materials and methods Risk-stratified clinical pathways for patients undergoing pancreatic surgery were implemented in 2016 at our instit...
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#1Casey J. Allen (University of Texas MD Anderson Cancer Center)H-Index: 3
#2Nikhil G. ThakerH-Index: 15
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