Effect of Enhanced Recovery After Surgery program on hospital stay and 90-day readmission after pancreaticoduodenectomy: a single, tertiary center experience in Korea

Abstract

Purpose: Despite increasing number of reports on Enhanced Recovery After Surgery program (ERAS) and readmission after pancreaticoduodenectomy (PD) from Western countries, there are very few reports on this topic from Asian countries. This study aimed to evaluate the effects of ERAS on hospital stay and readmission and to identify reasons and risk factors for readmission after PD. Methods: This retrospective cohort study included 670 patients who underwent open PD from January 2003 to December 2017. The patients were classified into ERAS (n = 352) and non-ERAS (n = 318) groups. Patients' characteristics, perioperative outcomes, and readmission rates were compared. Results: There were no significant differences in the postoperative complication rates between the groups. The mean postoperative hospital stay was significantly shorter in the ERAS group (24.5 vs. 18.0 days, P < 0.001), but the 90-day readmission rate was similar in the 2 groups (9.1% vs. 8.5%, P = 0.785). Complications associated with pancreatic fistula (42.4%) were the most common cause for readmission. In the multivariate analysis, diabetes mellitus (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.05-3.24; P = 0.034), preoperative non-jaundice (OR, 0.45; 95% CI, 0.25-0.82; P = 0.009) and severe postoperative complications (OR, 4.12; 95% CI, 2.34-7.26; P < 0.001) were identified as risk factors for readmission. Conclusion: The results confirmed that the ERAS program for PD was beneficial in reducing postoperative stay without increasing readmission risks. To decrease readmission rates, prudent discharge planning and medical support should be considered in patients who experience severe complications.

Is enhancing recovery after pancreatic cancer surgery even possible?—a narrative review

“…This may be attributed to the practice of "glocalization", which refers to simultaneous occurrence of both universalizing and particularizing tendencies in a contemporary system (97). Again, we noted a low representation of pre- (59,61,62,67,72,73,76,78,80,81,94,95) and intra-operative (59)(60)(61)(62)64,67,70,72,73,76,78,80,94,95) components in many of the institutional pathways. It is quite possible that some routine practices would not have been itemized as pathway components.…”

“…The search strategy identified 37 studies (https://cdn. amegroups.cn/static/public/cco-21-36-1.pdf) (85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96) published in the last 2 decades, including 4 RCTs (81,83,87,88). On comparing the components (pre-, intraand post-operative) of the pathways in these studies, we found considerable heterogeneity amongst institutional protocols.…”

Challenging issues of implementing enhanced recovery after surgery programs in South Korea

“…Additional-ly, one study was conducted in a foreign country and another did not include details about the ERAS protocol, leading to their exclusion. Finally, the remaining 16 studies were analyzed [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Table 1 presents the authorship status of anesthesiologists in these studies, along with the inclusion of ERAS items related to the field of anesthesiology.…”