Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study

Abstract

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. Meta-analysis showed a decrease in pancreatic fistula (OR = 0.79, 95% CI: 0.67 to 0.95; I 2 = 0%), infection (OR = 0.63, 95% CI: 0.50 to 0.78; I 2 = 0%), especially incision infection (OR = 0.62, 95% CI: 0.42 to 0.91; I 2 = 0%), and pulmonary infection (OR = 0.28, 95% CI: 0.12 to 0.66; I 2 = 0%). Length-of-stay (MD: −3.89 days, 95% CI: −4.98 to −2.81; I 2 = 78%) and cost were also significantly reduced. There was no significant increase in mortality, readmission, reoperation, or delayed gastric emptying. Conclusion: This analysis revealed that using ERAS protocols in pancreatic resections may help decrease the incidence of pancreatic fistula and infections. Furthermore, ERAS also reduces length of stay and cost of care. This study provides evidence for the benefit of ERAS protocols.

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

“…7 However, one more recent meta-analysis by Cao and his associates reported that ERAS reduced POPF rate, but had no influence on DGE rate. 8 The contradictory results might be related to their differences in inclusion criteria. The former enrolled the studies with only PD, while the latter included studies involving not only PD but also distal pancreatectomy.…”

“…7 However, another meta-analysis analyzed 19 non-randomized comparative studies and reported opposite results. 8 Recently, several randomized controlled trials (RCTs) have been reported in evaluating the efficacy and safety of ERAS protocol in PD. [9][10][11] Herein, we conducted this systematic review and meta-analysis with the aim at further evaluating the impact of ERAS on postoperative outcomes after PD by collecting more nonrandomized comparative studies and RCTs.…”

The Pertinent Literature of Enhanced Recovery after Surgery Programs: A Bibliometric Approach

“…Enhanced recovery after surgery (ERAS) is a series of effective perioperative interventions under the instruction of a multidisciplinary team, thus improving the surgical patients’ experiences both psychologically and physiologically [ 1 , 2 ]. Compared with the traditional perspective, the ERAS pathway is the new revolution for surgery, as it significantly decreases surgical complications, hospital stay, overall medical charges, and patient discomfort [ 3 , 4 , 5 ]. ERAS has a broad prospect of perioperative application, and an increasing number of surgery-related guidelines have been published in recent years.…”

Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy

“…The addition of ERAS ® to the pancreatic surgeons armamentarium has certainly helped improve outcomes[ 26 , 27 ], especially reductions in overall and minor morbidity, incidences of delayed gastric emptying, incisional and intra-abdominal infections, and shortened length of stay, without increasing 30-d readmission and mortality[ 9 ]. It has been reported that up to 30% of patients are unable to receive adjuvant chemotherapy for pancreatic cancer for a variety of reasons[ 28 ].…”