Enhanced Recovery After Surgery Pathway in Patients Undergoing Pancreaticoduodenectomy

Braga, Marco; Pecorelli, Nicolò; Ariotti, Riccardo; Capretti, Giovanni; Greco, Massimiliano; Balzano, Gianpaolo; Castoldi, R.; Beretta, Luigi

doi:10.1007/s00268-014-2653-5

Cited by 148 publications

(131 citation statements)

References 33 publications

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“…16 Braga et al evaluated the compliance to the enhanced recovery protocol and concluded that patients with low compliance had a higher incidence of complications. 40 Our results are in pursuance of previous studies that showed that a CP or standardized care plan for pancreaticoduodenectomy patients resulted in an earlier start of solid enteral feeding and a shorter hospital LOS and less readmissions. Importantly, protocol adherence to predefined targets has not been part of these studies as was analysis of the reasons not following the protocol and its association to outcome.…”

Section: Discussionsupporting

confidence: 61%

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

Kolk

Boogaard

Becking-Verhaar

et al. 2017

Journal of Gastrointestinal Surgery

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Introduction Medical and nursing protocols in perioperative care for pancreaticoduodenectomy are mainly mono-disciplinary, limiting their integration and transparency in a continuous health care system. The aims of this study were to evaluate adherence to a multidisciplinary clinical pathway for all pancreaticoduodenectomy patients during their entire hospital stay and to determine if the use of this clinical pathway is associated with beneficial effects on clinical end points. Materials and Methods A prospective cohort study was conducted in 95 pancreaticoduodenectomy patients treated according to a clinical pathway, including a variance report, compared to a historical control group (n = 52) with a traditional treatment regime. Results Process evaluation of the clinical pathway group revealed that protocol adherence throughout all units was above 80%. Major complications according to Clavien-Dindo classification grade ≥3 decreased from 27 to 13%; p = 0.02. Hospital length of stay was significantly shorter in the clinical pathway group, median 10 days ], compared with the control group, median 13 days ; p = 0.02. Conclusion The use of a clinical pathway in pancreaticoduodenectomy patients was associated with high protocol adherence, improved outcome and shorter hospital length of stay. Variance report analysis and protocol adherence with a Prepare-ActReflect Cycle are essential in surveillance of outcome.

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Section: Discussionsupporting

confidence: 61%

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

Kolk

Boogaard

Becking-Verhaar

et al. 2017

Journal of Gastrointestinal Surgery

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show abstract

“…Hence, studies that compared the length of hospitalization between patients operated on after the implementation of the ERAS protocol and patients operated on before its implementation concluded that the period after the start of the protocol entailed a shorter hospitalization and postoperative recovery (9)(10) . A randomized study also concluded that the ERAS protocol mitigates the surgical stress and accelerates the recovery, without increasing the morbidity and mortality rates (11) .…”

Section: The Projects Enhanced Recovery After Surgery (Eras) and The mentioning

confidence: 99%

Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries

Pereira

Turrini

Poveda

2017

Rev. esc. enferm. USP

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Objective:To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. Method: Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. Results: The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). Conclusion: The length of fasting is associated with complications that affect the quality of the patients' postoperative recovery and nurses' work. The nursing team should be alert to this aspect and being responsible for overseeing the patients' interest, should not permit the unnecessary extension of fasting.

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“…Kim [11] reported that energy intake via oral and intravenous injection approximates to 1,050 kcal/day in a group with postoperative PD patients. Enhanced recovery after surgery study also reported that adherence to postoperative targets was inappropriate: 55% for oral liquids and solid 53% for food [12]. And this study shows that low compliance to regimen was closely related to the severity of postoperative complications [12].…”

Section: Introductionmentioning

confidence: 85%

A Study on the Dietary Intake and the Nutritional Status among the Pancreatic Cancer Surgical Patients

et al. 2016

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The adequate dietary intake is important to maintain the nutritional status of the patients after pancreatic cancer surgery. This prospective study was designed to investigate the dietary intake and the nutritional status of the patients who had pancreatic cancer surgery. Thirty-one patients (15 men, 16 women) were enrolled and measured body weight, body mass index (BMI), nutritional risk index (NRI), and Malnutrition Universal Screening Tool (MUST). Actual oral intake with nutritional impact symptoms recorded on the clinical research foam at every meal and medical information were collected from electronic medical charts. The rates of malnutrition at admission were 45.1% (14/31) and 28.9% (9/31) by NRI and MUST method, respectively, but those were increased to 87% (27/31) and 86.6% (26/31) after operation on discharge. The median values of daily intake of energy, carbohydrates, fat, and protein were 588.1 kcal, 96.0 g, 11.8 g, and 27.0 g, respectively. Most patients (n = 20, 64.5%) experienced two or more symptoms such as anorexia, abdominal bloating and early satiety. There were negative correlations between C-reactive protein (CRP) levels and the intake of total energy, protein, fat, and zinc. The rates of malnutrition were increased sharply after surgery and the dietary intake also influenced the inflammatory indicators. The results suggested that need of considering special therapeutic diets for the patients who received pancreatic surgery.

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Enhanced Recovery After Surgery Pathway in Patients Undergoing Pancreaticoduodenectomy

Abstract: The ERAS pathway was feasible and safe, yielding an earlier postoperative recovery. An ERAS protocol should be implemented in patients undergoing PD; however, patients with early postoperative low compliance should be carefully managed.

Cited by 148 publications

References 33 publications

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries

A Study on the Dietary Intake and the Nutritional Status among the Pancreatic Cancer Surgical Patients

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