Implementation of an enhanced recovery programme following pancreaticoduodenectomy

Robertson, Nichola; Gallacher, Peter J.; Peel, Natalie; Garden, O. James; Duxbury, Mark; Lassen, Kristoffer; Parks, Rowan W.

doi:10.1111/j.1477-2574.2012.00521.x

Cited by 77 publications

(56 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other reports on ERAS and PD also did not show an increase in morbidity after implementing an ERAS program [26,27,28] and one report even showed a decrease in morbidity [29]. The rates of PD-specific complications such as DGE, pancreatic fistula, and post-PD hemorrhage observed in this study were comparable with other reports on fast track and PD [29,30]. Balzano et al [29] described a decrease in DGE after the institution of a fast-track protocol for PD from 24.6 to 13.9%.…”

Section: Discussionsupporting

confidence: 81%

“…This is probably explained by the increasing use of CT and advances in CT-guided percutaneous interventions. Relaparotomy rates decreased from 13 to 8%, which corresponds with other reports [29,30,31]. Readmission rates in the present study did not change significantly, which implies that earlier discharge in the years after implementation of the ERAS protocol did not affect patient morbidity.…”

Section: Discussionsupporting

confidence: 79%

See 1 more Smart Citation

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

et al. 2014

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 79%

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

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The ERAS program has recently been safely applied to major pancreatic resections, such as PD, with demonstrated improved short-term outcomes. 41,[47][48][49] One of the most reproducible predictors of successful ERAS is early oral nutrition, with clear fluids often initiated on postoperative day 1 and solid foods on postoperative days 3-5; this is earlier than reported by the majority of our study population, who are mostly not practising ERAS. Other critical features of ERAS include minimizing epidural use, Respondents, % limiting postoperative NG suction, removing drains early and ambulating early.…”

contrasting

confidence: 45%

“…They also contribute to prolonged hospital stays, and their early removal is a critical component of fast-track surgical pathways. 41 Thus, many authors advocate NG placement selectively in patients with delayed gastric emptying. 42,43 Our data demonstrate that the majority of respondents always or frequently use NG suction after PD, indicating an important evidence-practice gap in the surveyed population.…”

mentioning

confidence: 99%

Canadian practice patterns for pancreaticoduodenectomy

Cyr

Truong

Lam-McCulloch

et al. 2015

cjs

View full text Add to dashboard Cite

Background: Discordant practice patterns may be a consequence of evidence-practice gaps or deficiencies in knowledge translation. We examined the current strategies used by hepato-pancreatico-biliary (HPB) surgeons in Canada for the perioperative management of pancreaticoduodenectomy (PD). Methods:We generated a web-based survey that focused on the perioperative measures surrounding PD. The survey was distributed to all members of the Canadian Hepato-Pancreatico-Biliary Association. Results:The survey was distributed to 74 surgeons and received a response rate of 50%. Many similarities in surgical techniques were reported; for example, most surgeons (86.5%) reconstruct the pancreas with pancreaticojejunostomy rather than pancreaticogastrostomy. In contrast, variable techniques regarding the use of peritoneal drainage tubes, anastomotic stents, octreotide and other intraoperative modalities were reported. Most surgeons (75.7%) reported that their patients frequently required preoperative biliary drainage, yet there was minimal agreement with the designated criteria. There was variability in postoperative care, including the use of epidural analgesia and timing of postoperative oral nutrition. Conclusion:We identified heterogeneity among Canadian HPB surgeons, suggesting a number of evidence-practice gaps within specific domains of pancreatic resections. Focused research in these areas may facilitate technical agreement and improve patient outcomes following PD.Contexte : La discordance entre les modes de pratique pourrait être due à des lacunes au plan des pratiques fondées sur des preuves ou à une déficience du transfert des connaissances. Nous avons étudié les stratégies actuellement utilisées par les chirurgiens hépato-pancréato-biliaires (HPB) au Canada pour la prise en charge périopératoire de la pancréatoduodénectomie (PD). Méthodes :Nous avons préparé un questionnaire électronique sur les mesures péri-opératoires entourant la PD. Le questionnaire a été distribué à tous les membres de l'Association hépato-pancréato-biliaire canadienne.Résultats : Le questionnaire a été distribué à 74 chirurgiens et a généré un taux de réponse de 50 %. De nombreuses similitudes dans les techniques chirurgicales ont été signalées : par exemple, la majorité des chirurgiens (86,5 %) reconstruisent le pancréas par pancréatojéjunostomie plutôt que par pancréatogastrostomie. En revanche, on a observé une variabilité dans les techniques d'utilisation des drains péritonéaux, des endoprothèses anastomotiques, des octréotides et autres modalités peropératoires. La majorité des chirurgiens (75,7 %) ont signalé que leurs patients avaient souvent besoin de drains biliaires préopératoires et pourtant, les critères désignés ne semblaient pas faire l'unanimité. On a aussi noté des différences dans les soins postopératoires, y compris en ce qui concerne le recours à l'analgésie péridurale et le moment de la reprise de l'alimentation orale après la chirurgie. Conclusion :Nous avons observé une hétérogénéité dans la pratique des chirurgiens HP...

show abstract

“…The current article draws from recent guidelines recently published by the ERAS Society [2]. Encouragingly, the feasibility of introducing an enhanced recovery programme in pancreatic surgery has recently been demonstrated [3].…”

mentioning

confidence: 99%

Enhanced recovery after pancreatic surgery

Stutchfield¹,

Parks

2013

Sri Lanka j Surg

View full text Add to dashboard Cite

Implementation of an enhanced recovery programme following pancreaticoduodenectomy

Abstract: The ERAS protocol was implemented safely. Achieving certain targets was challenging. Non-medical causes remain a significant factor in delayed discharge following PD.

Cited by 77 publications

References 65 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

Canadian practice patterns for pancreaticoduodenectomy

Enhanced recovery after pancreatic surgery

Contact Info

Product

Resources

About