Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Lassen, Kristoffer; Coolsen, Mariëlle M.E.; Slim, K.; Carli, Francesco; Aguilar-Nascimento, José Eduardo de; Schäfer, Markus; Parks, Rowan W.; Fearon, Kenneth C. H.; Lobo, Dileep N.; Demartines, Nicolas; Braga, Marco; Ljungqvist, Olle; Dejong, Cornelis H. C.

doi:10.1016/j.clnu.2012.08.011

Cited by 512 publications

(465 citation statements)

References 171 publications

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“…In 2009 a concept protocol was established and has been used ever since. The ERAS pancreas collaborative group, in which MUMC also participates, recently developed a consensus protocol for ERAS in PD [17]. This consensus protocol will be implemented from 2013 onwards and will be evaluated in a multicenter international prospective trial.…”

Section: Introductionmentioning

confidence: 99%

Improving Outcome after Pancreaticoduodenectomy: Experiences with Implementing an Enhanced Recovery After Surgery (ERAS) Program

et al. 2014

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Background: Pancreaticoduodenectomies (PDs) are complex surgical procedures that require high-standard perioperative care. The objective of this study was to evaluate the effects of implementing an Enhanced Recovery After Surgery (ERAS) program for PD on patient outcome. Methods: 230 patients undergoing PD in the Maastricht University Medical Centre between January 1995 and January 2012 were included. Group 1 (no ERAS; 1995-2005) received traditional care. From January 2006, several elements of an ERAS pathway for pancreatic surgery were implemented (group 2: ‘ERAS-like'). From 2009 onwards the ERAS pathway was fully implemented (group 3: ERAS). Mortality, complications, readmissions and length of hospital stay (LOS) were evaluated in the subgroups and compared. Results: Median LOS was significantly reduced from 20 days in group 1 to 13 days in group 2 and 14 days in group 3 (p = 0.001). Median LOS of patients without complications was 16, 10 and 9 days in groups 1, 2 and 3, respectively (p < 0.0001). Over time, the average age of patients undergoing PD increased significantly. Complication rates as well as mortality and readmission rates did not change over time. Conclusion: Implementing an ERAS program contributed to a decrease of LOS without compromising other outcomes. Mortality, morbidity and readmission rates stayed unchanged and more complications were managed non-operatively.

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Section: Introductionmentioning

confidence: 99%

Improving Outcome after Pancreaticoduodenectomy: Experiences with Implementing an Enhanced Recovery After Surgery (ERAS) Program

et al. 2014

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“…However, despite a number of studies aimed at understanding whether technical factors contribute to outcome,41 – 43 postoperative morbidity remains high, ranging from 38% to 50%, and mostly comprised of infectious complications 36 44 45. Thus, newer studies have examined the importance of a broader approach that involves revising preoperative risk assessment,46 use of perioperative antibiotic prophylaxis,47 – 49 and refinement of the indications for preoperative biliary drainage.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a dual-ring wound protector for prevention of incisional surgical site infection after Whipple's procedure (pancreaticoduodenectomy) with preoperatively-placed intrabiliary stents: protocol for a randomised controlled trial

et al. 2014

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IntroductionAmong surgical oncology patients, incisional surgical site infection is associated with substantially increased morbidity, mortality and healthcare costs. Moreover, while adults undergoing pancreaticoduodenectomy with preoperative placement of an intrabiliary stent have a high risk of this type of infection, and wound protectors may significantly reduce its risk, no relevant studies of wound protectors yet exist involving this patient population. This study will evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among adults undergoing pancreaticoduodenectomy with preoperatively-placed intrabiliary stents.Methods and analysisThis study will be a parallel, dual-arm, randomised controlled trial that will utilise a more explanatory than pragmatic attitude. All adults (≥18 years) undergoing a pancreaticoduodenectomy at the Foothills Medical Centre in Calgary, Alberta, Canada with preoperative placement of an intrabiliary stent will be considered eligible. Exclusion criteria will include patient age <18 years and those receiving long-term glucocorticoids. The trial will employ block randomisation to allocate patients to a commercial dual-ring wound protector (the Alexis Wound Protector) or no wound protector and the current standard of care. The main outcome measure will be the rate of surgical site infection as defined by the Centers for Disease Control and Prevention criteria within 30 days of the index operation date as determined by a research assistant blinded to treatment allocation. Outcomes will be analysed by a statistician blinded to allocation status by calculating risk ratios and 95% CIs and compared using Fisher's exact test.Ethics and disseminationThis will be the first randomised trial to evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among patients undergoing pancreaticoduodenectomy. Results of this study are expected to be available in 2016/2017 and will be disseminated using an integrated and end-of-grant knowledge translation strategy.Trial registration numberClinicalTrials.gov identifier NCT01836237.

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“…Its motto is: "The mission of the ERAS Society is to develop perioperative care and to improve recovery through research, education, audit, and implementation of evidence-based practice" [1]. The recommendations for gastrointestinal [13][14][15][16], bariatric [17], and oncologic [18][19][20] surgical procedures have already been published. There is increasingly strong evidence that the guidelines may be found useful in some other surgical fields, such as orthopaedics, urology, as well as thoracic, maxillofacial, and reconstructive surgery [21][22][23][24][25][26].…”

Section: Enhanced Recovery After Surgerymentioning

confidence: 99%

“…The suggested protocol of management has been adapted in almost all non-cardiac surgery specialities [13][14][15][16][17][18][19][20][21][22][23][24][25][26]; yet it is cardiac surgery, which is the most common procedure performed worldwide and is associated with high healthcare expenditures. Patients are increasingly old and have additional comorbidities, thus the risk of surgery increases.…”

Section: Enhanced Recovery Aftermentioning

confidence: 99%

It is time for enhanced recovery after surgery in cardiac surgery

Krzych

Kucewicz‐Czech²

2017

Kardiol Pol

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Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Cited by 512 publications

References 171 publications

Improving Outcome after Pancreaticoduodenectomy: Experiences with Implementing an Enhanced Recovery After Surgery (ERAS) Program

Improving Outcome after Pancreaticoduodenectomy: Experiences with Implementing an Enhanced Recovery After Surgery (ERAS) Program

Efficacy of a dual-ring wound protector for prevention of incisional surgical site infection after Whipple's procedure (pancreaticoduodenectomy) with preoperatively-placed intrabiliary stents: protocol for a randomised controlled trial

It is time for enhanced recovery after surgery in cardiac surgery

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