Impact of enhanced recovery after surgery protocol on pancreaticoduodenectomy: a meta-analysis of non-randomized and randomized controlled trials

Published on Oct 1, 2020in Hpb3.647
· DOI :10.1016/J.HPB.2020.07.001
Xi-Yu Wang2
Estimated H-index: 2
(SYSU: Sun Yat-sen University),
Jian-Peng Cai8
Estimated H-index: 8
(SYSU: Sun Yat-sen University)
+ 2 AuthorsXiao-Yu Yin18
Estimated H-index: 18
(SYSU: Sun Yat-sen University)
Sources
Abstract
Abstract Background Enhanced recovery after surgery (ERAS) has been widely applied in many surgical specialties. However, with respect to the impact of ERAS on pancreaticoduodenectomy (PD), there still exist some controversies. Methods Literature search was performed in PubMed, Web of Science and the Cochrane Library from January, 1990 to July, 2019. A meta-analysis was performed using fixed-effects or random-effects models. Results Twenty-two studies containing 4147 patients were identified. The entire pooled data showed that ERAS significantly reduced overall and minor morbidity (RR: 0.80, 95% CI: 0.72–0.88, p  Conclusion ERAS significantly reduced overall and minor morbidity, incidences of DGE, incisional and intra-abdominal infections, and shortened LOS in PD, without increasing 30-day readmission and mortality. However, more large-scale randomized controlled trials are still needed to confirm the findings.
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References48
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#2Hwa Jung Kim (UOU: University of Ulsan)H-Index: 2
Last. Song Cheol Kim (UOU: University of Ulsan)H-Index: 35
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BACKGROUND: This study aims to investigate the noninferiority of Enhanced Recovery After Surgery (ERAS) for pancreaticoduodenectomy (PD). METHODS: In this single-center trial, we randomly assigned 276 adult patients who underwent open PD into ERAS and conventional groups with 138 patients in each, from 2015 through 2017. The primary endpoint was the incidence of overall morbidity until postoperative 3 months. The secondary endpoints were in-hospital or 30-day mortality, postoperative length of s...
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#1Yang Cao (HUM: Hubei University of Medicine)H-Index: 1
#2Hui-Yun Gu (WHU: Wuhan University)H-Index: 6
Last. Yan Fu (HUM: Hubei University of Medicine)H-Index: 3
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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. Met...
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#1Ye LiH-Index: 3
#2Fang ZhouH-Index: 1
Last. Jian Zhou (Soochow University (Suzhou))H-Index: 148
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Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy
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#5K. Lee (University of Pittsburgh)H-Index: 21
OBJECTIVE: To determine the impact of enhanced recovery after surgery (ERAS) pathway implementation on outcomes, and cost of robotic and open pancreatoduodenectomy. BACKGROUND: ERAS pathways have shown benefit in open pancreatoduodenectomy (OPD). The impact of ERAS on robotic pancreatoduodenectomy (RPD) is unknown. METHODS: Retrospective review of consecutive RPD and OPDs in the pre-ERAS (July, 2014-July, 2015) and ERAS (July, 2015-July, 2016) period. Univariate and multivariate logistic regress...
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#1Sara K. Daniel (UW: University of Washington)H-Index: 5
#2Lucas W. Thornblade (UW: University of Washington)H-Index: 9
Last. Venu G. Pillarisetty (UW: University of Washington)H-Index: 30
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Introduction Pancreaticoduodenectomy is a complex surgical procedure associated with high morbidity and prolonged length of stay. Enhanced recovery after surgery principles have reduced complications rate and length of stay for multiple types of operations. We hypothesized that implementation of a standardized perioperative care pathway would facilitate safe discharge by five days after pancreaticoduodenectomy. Methods We performed a retrospective cohort study of patients undergoing pancreaticod...
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#1Kosei Takagi (Okayama University)H-Index: 10
#2Ryuichi Yoshida (Okayama University)H-Index: 17
Last. Toshiyoshi Fujiwara (Okayama University)H-Index: 64
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Summary Background & aims Evidence of the advantages of enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) is limited. The aim of this study was to examine the efficiency of ERAS protocols in patients following PD. Methods Between June 2014 and October 2016, patients undergoing PD were randomly assigned to receive ERAS protocols or standard care. The primary endpoint was the postoperative length of stay. Secondary endpoints included postoperative complication...
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AbstractEnhanced recovery after surgery (ERAS) programs have been shown to decrease postoperative complications and hospital stay in pancreaticoduodenectomy. However, no studies concerned recovery after discharge except readmission. This study evaluated an ERAS program for pancreaticoduodenectomy fr
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#1Cesar Aviles (Carolinas Medical Center)H-Index: 2
#2Marilyn J. Hockenberry (Duke University)H-Index: 29
Last. Janet Desamero (Carolinas Medical Center)H-Index: 1
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Abstract Pancreatic adenocarcinoma is an aggressive cancer that carries a poor prognosis. Pancreaticoduodenectomy (PD) offers the only potential cure, but the associated morbidity is high. The Enhanced Recovery After Surgery (ERAS) evidence-based guidelines for perioperative care for PD can be used to reduce variations in practice. . The primary aim was to evaluate the feasibility of the ERAS guidelines for patients undergoing PD. Secondary aims were to assess length of stay (LOS), readmission w...
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// Xiaxing Deng 1, * , Xi Cheng 1, * , Zhen Huo 1, * , Yuan Shi 1 , Zhijian Jin 1 , Haoran Feng 1 , Yue Wang 1 , Chenlei Wen 1 , Hao Qian 1 , Ren Zhao 1 , Weihua Qiu 1 , Baiyong Shen 1 and Chenghong Peng 1 1 Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China * These authors have contributed equally to this work Correspondence to: Chenghong Peng, email: pchccr@163.com Baiyong Shen, email: sbyccr@163.com Weihua Qiu, email: drqwh2003@126...
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#2Michael J. Scott (National Health Service)H-Index: 23
Last. Kenneth C. H. Fearon (RIE: Edinburgh Royal Infirmary)H-Index: 100
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Importance Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Observations Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care fo...
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#1Carlos I. Ayala (Stanford University)
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Abstract null null Background null Enhanced Recovery After Surgery (ERAS) protocols have been successfully instituted for pancreaticoduodenectomy (PD). This study evaluates reasons patients fail to meet length of stay (LOS) and areas for pathway improvement. null null null Materials and Methods null A multidisciplinary team developed and implemented an ERAS protocol for open PD in 2017. The study includes a medical record review of all patients who were perioperatively managed with the ERAS prot...
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#1Monish KarunakaranH-Index: 2
#2Pavan JonnadaH-Index: 2
Last. Savio G. Barreto (Flinders University)H-Index: 22
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BACKGROUND Clinical pathways (CP) based on Enhanced recovery after surgery (ERAS®) are increasingly utilised in patients undergoing pancreatoduodenectomy (PD). This systematic review aimed to compare the impact of CPs versus conventional care (CC) on peri-PD costs. METHODS A systematic review of major reference databases was undertaken. Quality assessment was performed using the CHEERS checklist. Incremental cost-effectiveness ratios were calculated as part of the cost-effectiveness analysis. A ...
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#1Jesse V. Groen (LUMC: Leiden University Medical Center)H-Index: 5
#2R.B. Henrar (LUMC: Leiden University Medical Center)
Last. J. Sven D. Mieog (LUMC: Leiden University Medical Center)H-Index: 23
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Abstract null null Background null The aim of this survey was to assess practices regarding pain management, fluid therapy and thromboprophylaxis in patients undergoing pancreatoduodenectomy on a global basis. null null null Methods null This survey study among surgeons from eight (inter)national scientific societies was performed according to the CHERRIES guideline. null null null Results null Overall, 236 surgeons completed the survey. ERAS protocols are used by 61% of surgeons and respectivel...
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#1Luke Dosselman (UTSW: University of Texas Southwestern Medical Center)H-Index: 3
#2Mark N. Pernik (UTSW: University of Texas Southwestern Medical Center)H-Index: 5
Last. Carlos A. Bagley (UTSW: University of Texas Southwestern Medical Center)H-Index: 30
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OBJECTIVE Differences in insurer and payer status have been shown to increase patient hospital length of stay (LOS) by delaying the approval of transfer to a rehabilitation facility. The aim of the current study is to determine the impact of the type of insurance provider on postoperative hospital LOS after spine surgery. METHODS In our single-institution retrospective study, all patients undergoing elective spine surgery between August 2018 and August 2019 as part of an enhanced recovery after ...
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#1Zhe Cao (Peking Union Medical College Hospital)H-Index: 15
#2Jiangdong Qiu (Peking Union Medical College Hospital)H-Index: 9
Last. Bei Sun (HMU: Harbin Medical University)H-Index: 3
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BACKGROUND Prophylactic somatostatin to reduce the incidence of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy remains controversial. We assessed the preventive efficacy of somatostatin on clinically relevant postoperative pancreatic fistula in intermediate-risk patients who underwent pancreaticoduodenectomy at pancreatic centres in China. METHODS In this multicentre, prospective, randomised controlled trial, we used the updated postoperative pancreatic fistul...
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#1Narongsak Rungsakulkij (MU: Mahidol University)H-Index: 7
#2Varinthip Thongchai (MU: Mahidol University)
Last. Suraida Aeesoa (MU: Mahidol University)H-Index: 6
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Objective The objective of this study was to examine the relationship between the rate of bilirubin decrease following preoperative biliary drainage before pancreaticoduodenectomy and postoperative morbidity. Methods Records of patients who underwent pancreaticoduodenectomy at the Department of Surgery in Ramathibodi Hospital between January 2008 and December 2019 were retrospectively reviewed. The patients were classified into either an adequate or inadequate drainage rate groups according to t...
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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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Several benefits have been reported after applying the principles of enhanced recovery after surgery (ERAS) into the perioperative care of patients undergoing robot-assisted radical prostatectomy (RARP). Nevertheless, there are still barriers. We aimed to identify the key areas by systematically surveying urology departments in Germany and Austria. A 27-question survey on the adoption of ERAS principles for the perioperative care of RARP patients was designed, in compliance with the guidelines o...
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#1Monish KarunakaranH-Index: 2
#2Pavan Jonnada (Kidwai Memorial Institute of Oncology)H-Index: 2
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Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy
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Enhanced recovery after surgery (ERAS) initially started in the early 2000s as a series of protocols to improve the perioperative care of surgical patients. They aimed to increase patient satisfaction while reducing postoperative complications and postoperative length of stay. Despite these protocols being widely adopted in many fields of surgery, they are yet to be adopted in pancreatic transplantation: a high-risk surgery with often prolonged length of postoperative stay and high rate of compl...
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