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Enhanced recovery after pancreatic surgery: a systematic review of the evidence

Published on Jan 1, 2015in Hpb3.047
· DOI :10.1111/hpb.12265
Daniel J. Kagedan7
Estimated H-index: 7
,
Mahrosh Ahmed1
Estimated H-index: 1
(Princess Margaret Cancer Centre)
+ 1 AuthorsAlice C. Wei17
Estimated H-index: 17
(U of T: University of Toronto)
Abstract
Background Enhanced recovery after surgery (ERAS) protocols have been shown to reduce hospital stay without compromising outcomes. Attempts to apply ERAS principles in the context of pancreatic surgery have generated encouraging results. A systematic review of the current evidence for ERAS following pancreatic surgery was conducted.
  • References (32)
  • Citations (66)
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References32
Newest
#1George Van Buren (BCM: Baylor College of Medicine)H-Index: 18
#2Mark Bloomston (OSU: Ohio State University)H-Index: 40
Last. William E. Fisher (BCM: Baylor College of Medicine)H-Index: 42
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Abstract To test by randomized prospective multicenter trial the hypothesis that pancreaticoduodenectomy (PD) without the use of intraperitoneal drainage does not increase the frequency or severity of complications. Some surgeons have abandoned the use of drains placed during pancreas resection. We randomized 137 patients to PD with (n = 68, drain group) and without (n = 69, no-drain group) the use of intraperitoneal drainage and compared the safety of this approach and spectrum of complications...
180 CitationsSource
#1Charity C. Glass (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 10
#2Stephen Gondek (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 6
Last. Tara S. Kent (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 23
view all 5 authors...
Background: Readmissions after pancreatectomy, largely for the management of complications, may also occur as a result of failure to thrive or for diagnostic endeavours. Potential mechanisms to reduce readmission rates may be elucidated by assessing the adequacy of the initial disposition and the real necessity for readmission. Methods: Using previously identified categories of readmission following pancreatectomy, details of reasons for and results of readmissions were scrutinized using a root ...
14 CitationsSource
#2R. M. van DamH-Index: 11
Last. Cornelis H.C. Dejong (Maastricht University Medical Centre)H-Index: 64
view all 6 authors...
Background In the past decade, Enhanced Recovery after Surgery (ERAS) protocols have been implemented in several fields of surgery. With these protocols, a faster recovery and shorter hospital stay can be accomplished without an increase in morbidity or mortality. The purpose of this study was to review systematically the evidence for implementation of an ERAS protocol in pancreatic resections, with particular emphasis on pancreaticoduodenectomies (PDs).
114 CitationsSource
#1Vishes V. Mehta (Emory University)H-Index: 3
#2Sarah B. Fisher (Emory University)H-Index: 17
Last. David A. Kooby (Emory University)H-Index: 49
view all 6 authors...
Background Routine use of operative (primary) drains after pancreaticoduodenctomy (PD) remains controversial. We reviewed our experience with PD for postoperative (secondary) drainage and postoperative pancreatic fistula (POPF) rates based on use of primary drains. Study Design We identified consecutive patients who underwent PD between 2005 and 2012 from our pancreatectomy database. Primary closed suction drains were placed at the surgeon's discretion. Patient and operative factors were assesse...
66 CitationsSource
#1Freek Gillissen (Maastricht University Medical Centre)H-Index: 5
#2Christiaan HoffH-Index: 1
Last. Cornelis H.C. Dejong (Maastricht University Medical Centre)H-Index: 64
view all 7 authors...
Background It has been clearly shown that after elective colorectal surgery patients benefit from multimodal perioperative care programs. The Dutch Institute for Health Care Improvement started a breakthrough project to implement a multimodal perioperative care program of enhanced recovery after surgery (ERAS). This pre/post noncontrolled study evaluated the success of large-scale implementation of the ERAS program for elective colonic surgery using the breakthrough series.
72 CitationsSource
#1Mehrdad Nikfarjam (University of Melbourne)H-Index: 26
#2Laurence Weinberg (University of Melbourne)H-Index: 19
Last. Christopher Christophi (University of Melbourne)H-Index: 34
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Context Factors affecting length of hospital stay after uncomplicated pancreaticoduodenectomy have not been reported. We hypothesized that patients undergoing uncomplicated pancreaticoduodenectomy treated by fast track recovery program would have a shorter length of hospital stay compared to those managed by a standard program. Methods Patients without surgical or medical complications following pancreaticoduodenectomy managed by fast track or standard protocols, between 2005 and 2011, were iden...
28 CitationsSource
#1M. Abu Hilal (University Hospital Southampton NHS Foundation Trust)H-Index: 27
#2Francesco Di Fabio (University Hospital Southampton NHS Foundation Trust)H-Index: 15
Last. Neil W. Pearce (University Hospital Southampton NHS Foundation Trust)H-Index: 22
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Abstract Introduction Data on enhanced recovery programmes after pancreatoduodenectomy (ERP-PD) is limited. The aim of this pilot study was to evaluate the feasibility, safety and clinical outcomes of ERP-PD when implemented at a high-volume UK university referral centre. Methods This was an observational single-surgeon case-control study (before-and-after pathway). A total of 20 consecutive patients were prospectively enrolled for the ERP-PD and compared with 24 consecutive patients previously ...
38 CitationsSource
#1Nichola Robertson (RIE: Edinburgh Royal Infirmary)H-Index: 1
#2Peter James Gallacher (RIE: Edinburgh Royal Infirmary)H-Index: 1
Last. Rowan W. Parks (RIE: Edinburgh Royal Infirmary)H-Index: 38
view all 7 authors...
Objectives The aim of this prospective study was to investigate the implementation of an enhanced recovery after surgery (ERAS) programme following pancreaticoduodenectomy (PD).
44 CitationsSource
#1Noah M. Ivers (Women's College Hospital)H-Index: 28
#2Gro JamtvedtH-Index: 27
Last. Andrew D OxmanH-Index: 96
view all 10 authors...
Background Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. Despite its prevalence as a quality improvement strategy, there remains uncertainty regarding both the effectivenes...
3,574 CitationsSource
INTRODUCTION The terms ‘enhanced recovery after surgery’, ‘enhanced recovery programme’ (ERP) and ‘fast track surgery’ refer to multimodal strategies aiming to streamline peri-operative care pathways, to maximise effectiveness and minimise costs. While the results of ERP in colorectal surgery are well reported, there have been no reviews examining if these concepts could be applied safely to hepatopancreatobiliary (HPB) surgery. The aim of this systematic review was to appraise the current evide...
64 CitationsSource
Cited By66
Newest
Last. Feng Yongdong (HUST: Huazhong University of Science and Technology)H-Index: 2
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Purpose This study aimed to assess the safety and efficiency of the enhanced recovery after surgery (ERAS) protocol in radical gastrectomy. Methods Studies published before February 2019 were searched from EMBASE, PubMed, Cochrane Library and Quanfang databases without language and region restrictions. A total of 15 randomised controlled trials (RCTs) with 1216 participants were included in the analysis, of whom 605 underwent ERAS protocol and 611 received traditional perioperative treatment for...
Source
#1Neil Bibby (Manchester Royal Infirmary)
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Abstract Malnutrition and cancer cachexia are prevalent in older people with hepato-pancreatico-biliary (HPB) malignancy, with the resultant loss of muscle mass and function accelerating normal age-associated losses. Unintentional weight loss may be missed in patients with pre-illness obesity, delaying diagnosis and limiting treatment potential and access. Sarcopenia and/or sarcopenic obesity increase the risk of dose-limiting chemotherapy toxicity, post-operative mortality and overall survival....
Source
BACKGROUND: Postoperative pancreatic fistula (POPF) is the most serious complication following pancreaticoduodenectomy (PD). Identifying patients at high or low risk of developing POPF is important in perioperative management. This study aimed to determine a predictive risk score for POPF following PD, and compare it to preexisting scores. METHODS: All patients who underwent open PD from 2012 to 2017 in two high-volume centers were included. The training dataset was used for the development of t...
Source
#1Jens C. KubitzH-Index: 5
#1Jens C. KubitzH-Index: 8
Last. Evaldas GirdauskasH-Index: 20
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Protocols for “Enhanced recovery after surgery (ERAS)” are on the rise in different surgical disciplines and represent one of the most important recent advancements in perioperative medical care. In cardiac surgery, only few ERAS protocols have been described in the past. At University Heart Center Hamburg, Germany, we invented an ERAS protocol for patients undergoing minimally invasive cardiac valve surgery. In this retrospective single center study, we aimed to describe the implementation of o...
Source
#1Yung Lee (McMaster University)H-Index: 7
#2James Yu (McMaster University)H-Index: 4
Last. Dennis Hong (McMaster University)H-Index: 12
view all 5 authors...
Abstract Enhanced recovery after surgery (ERAS) protocols have been effective in improving postoperative recovery after major abdominal surgeries including colorectal cancer surgery, however its impact after gastric cancer surgery is unclear. A systematic review and meta-analysis was conducted to evaluate the effect of ERAS after gastric cancer surgery. Medline, EMBASE, CENTRAL, and PubMed was searched from database inception to December 2018. Randomized controlled trials (RCTs) comparing ERAS v...
1 CitationsSource
#1Gaëtan-Romain Joliat (UNIL: University of Lausanne)H-Index: 4
#2Martin Hübner (UNIL: University of Lausanne)H-Index: 26
Last. Nicolas Demartines (UNIL: University of Lausanne)H-Index: 46
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Background Enhanced recovery programs (ERPs) have been shown to improve postoperative outcomes after abdominal surgery. This study aimed to review the current literature to assess if ERPs in colorectal, pancreas, and liver surgery induce cost savings.
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Simultaneous with the introduction of enhanced recovery after surgery (ERAS) pathways have been the introduction and expansion of minimally invasive techniques (MIS) for surgery that in many cases have become standard practice. These minimally invasive techniques have become embedded in many ERAS protocols because of the obvious benefits in reducing access trauma, reducing pain and therefore requirement for opiate analgesia, minimizing fluid shifts, and reducing complications such as ileus, bloo...
Source
#1David J. MartinH-Index: 22
Last. Markus SchäferH-Index: 35
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Abstract Background There is still a lack of good evidence regarding the optimal perioperative nutritional management for patients undergoing pancreatoduodenectomy (PD). The aim of this international survey was to assess the current practice among pancreatic surgeons. Methods A web survey of 30 questions was sent to the members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA). All members were invited by email t...
1 CitationsSource
#1Julie PerinelH-Index: 9
#2Antoine DuclosH-Index: 19
Last. Mustapha AdhamH-Index: 23
view all 6 authors...
BACKGROUND: Implementation of enhanced recovery after surgery (ERAS) program after pancreatic surgery was associated with decreased length of stay (LOS). However, there were only retrospective uncontrolled before-after study, and care protocols were heterogeneous. We aimed to evaluate the impact of ERAS program on postoperative outcomes after pancreatectomy through a prospective controlled study. METHODS: A before/after study with a contemporary control group was undertaken in patients undergoin...
2 CitationsSource
#1Michael L. Boisen (University of Pittsburgh)H-Index: 3
#2Alexandra J. McQuaid (University of Pittsburgh)H-Index: 1
Last. Kathirvel Subramaniam (University of Pittsburgh)H-Index: 14
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Abstract Background Intrathecal morphine (ITM) and peripheral nerve blocks are accepted techniques for analgesia after abdominal surgery, but their efficacy has not been evaluated in the context of an enhanced recovery pathway (ERP) in pancreatic surgery. Materials and methods We retrospectively compared postoperative analgesia (pain scores and opioid requirements) after open or robotic pancreatoduodenectomy or distal pancreatectomy among ERP patients receiving either ITM or transversus abdomini...
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