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Fast Track—Different Implications in Pancreatic Surgery

Published on Jun 25, 2007in Journal of Gastrointestinal Surgery2.69
· DOI :10.1007/s11605-007-0167-2
Pascal O. Berberat34
Estimated H-index: 34
(Heidelberg University),
H. Ingold1
Estimated H-index: 1
(Heidelberg University)
+ 6 AuthorsMarkus W. Büchler125
Estimated H-index: 125
(Heidelberg University)
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Abstract
Concepts in “fast-track” surgery, which provide optimal perioperative care, have been proven to significantly reduce complication rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the outcomes of major pancreatic resections. Perioperative data from 255 consecutive patients, who underwent pancreatic resection by means of fast-track surgery in a high-volume medical center, were analyzed using univariate and multivariate models. Of the 255 patients, 180 received a pancreatic head resection and 51 received distal, 15 received total, and 9 received segmental pancreatectomies. The patients were discharged on median day 10 with a 30-day readmission rate of 3.5%. The in-hospital mortality was 2%, whereas medical and surgical morbidities were 17 and 25%, respectively. Fast-track parameters, such as first stools, normal food, complete mobilization, and return to normal ward, correlated significantly with early discharge (p < 0.05). Patients’ age, operation time, and early extubation proved to be independent factors of early discharge, shown through multivariate analysis (odds ratio: 4.0, 2.0, and 2.8, respectively; p < 0.05). Low readmission, mortality, and morbidity rates demonstrate that fast-track surgery is in fact feasible and safe and promotes earlier discharge without compromising patient outcomes.
  • References (40)
  • Citations (95)
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References40
Newest
Published on Nov 1, 2005in Archives of Surgery
Mark Hartel18
Estimated H-index: 18
,
Moritz N. Wente36
Estimated H-index: 36
+ 5 AuthorsMarkus W. Büchler125
Estimated H-index: 125
Hypothesis Antecolic duodenojejunostomy prevents delayed gastric emptying (DGE) after a pylorus-preserving Whipple (ppW) procedure better than retrocolic duodenojejunostomy. Design A single operation team’s experience with antecolic and retrocolic duodenojejunostomy in ppW is analyzed on a prospective database using univariate and multivariate models. Setting Tertiary referral center that focuses on pancreatic diseases. Patients and Interventions One hundred consecutive patients undergoing a ppW...
Published on May 1, 2005in Colorectal Disease3.00
Henrik Kehlet105
Estimated H-index: 105
,
Russell Williamson4
Estimated H-index: 4
(GSK: GlaxoSmithKline)
+ 1 AuthorsRobert W. Beart70
Estimated H-index: 70
(SC: University of Southern California)
Objective Postoperative ileus (POI) can negatively affect patient recovery and morbidity, yet the lack of an internationally accepted definition and clinical management pathway for this condition suggest POI may be under-recognized as a clinical problem. The purpose of this survey was therefore to assess current attitudes of surgeons towards the clinical impact and management of POI. Subjects and methods Telephone interviews were conducted with 230 surgeons from hospitals in the UK, France, Germ...
Published on Mar 1, 2005in Annals of Surgery9.48
Linda Basse11
Estimated H-index: 11
,
Dorthe Hjort Jakobsen6
Estimated H-index: 6
+ 5 AuthorsHenrik Kehlet105
Estimated H-index: 105
Open colonic resection is usually associated with a hospital stay of about 6 to 11 days and a complication rate of 15% to 20%.1–6 Introduction of laparoscopic-assisted colonic resection has reduced the hospital stay to about 4 to 8 days, with the same or a slightly lower morbidity rate in randomized trials.1–6 Concomitant with these technical developments, an increased body of evidence has been developed to demonstrate that perioperative care regimens, including optimized pain relief, early oral...
Published on Jul 1, 2004in Archives of Surgery
Christian Schmidt46
Estimated H-index: 46
(IU: Indiana University),
Emilie Susan Powell13
Estimated H-index: 13
(IU: Indiana University)
+ 23 AuthorsThomas A. Broadie18
Estimated H-index: 18
(IU: Indiana University)
Hypothesis Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions. Design Retrospective review of a prospectively collected database. Setting Academic tertiary care hospital. Patients A total of 516 consecutive patients who underwent PD. Main Outcome Measures Patient outcomes and survival factors. Results Pathological examination demonstrated 57% periampullary cancers, 22% chronic pancreatitis, 12% cystic neoplasms, 4% islet cell neoplasms, and 5% other. Fifty...
Published on May 1, 2004in Chirurg0.67
W. Schwenk23
Estimated H-index: 23
,
W. Raue15
Estimated H-index: 15
+ 2 AuthorsJ. M. Müller27
Estimated H-index: 27
Published on May 1, 2004
W. Schwenk23
Estimated H-index: 23
(Humboldt University of Berlin),
W. Raue2
Estimated H-index: 2
(Humboldt University of Berlin)
+ 2 AuthorsJ. M. Müller27
Estimated H-index: 27
(Humboldt University of Berlin)
Einleitung Die Rate allgemeiner Komplikationen nach elektiven Kolonresektionen und „traditioneller“ perioperativer Therapie soll durch multimodale perioperative Behandlungskonzepte reduziert werden und eine Entlassung innerhalb weniger Tage nach der Operation ermoglichen.
Published on May 1, 2004in Journal of The American College of Surgeons4.45
Amy M Lightner4
Estimated H-index: 4
(UCSF: University of California, San Francisco),
Robert E. Glasgow18
Estimated H-index: 18
(UCSF: University of California, San Francisco)
+ 4 AuthorsKimberly S. Kirkwood17
Estimated H-index: 17
(UCSF: University of California, San Francisco)
Abstract Background Elderly patients undergoing pancreatic resection present unique challenges in postoperative care. Although mortality rates among elderly patients after pancreatectomy at high-volume centers is known to be low, the anticipated decline in functional status and nutritional parameters has received little attention. Functional decline is an unrecognized but critically important consequence of pancreatic resection in older patients. Study design This study is a retrospective review...
Published on May 1, 2004in British Journal of Surgery5.59
Markus Wagner27
Estimated H-index: 27
,
Claudio A. Redaelli25
Estimated H-index: 25
+ 3 AuthorsMarkus W. Büchler125
Estimated H-index: 125
(Heidelberg University)
Background: Mortality rates associated with pancreatic resection for cancer have steadily decreased with time, but improvements in long-term survival are less clear. This prospective study evaluated risk factors for survival after resection for pancreatic adenocarcinoma. Methods: Data from 366 consecutive patients recorded prospectively between November 1993 and September 2001 were analysed using univariate and multivariate models. Results: Fifty-eight patients (15·8 per cent) underwent surgical...
Published on Mar 1, 2004in Scandinavian Journal of Surgery1.53
D. Hjort Jakobsen1
Estimated H-index: 1
(UCPH: University of Copenhagen),
E. Sonne3
Estimated H-index: 3
+ 2 AuthorsHenrik Kehlet105
Estimated H-index: 105
(UCPH: University of Copenhagen)
Background: Multi-modal rehabilitation programmes may improve early postoperative body composition, pulmonary function, exercise capacity, and reduce hospital stay. So far, no data are available on convalescence after discharge. Aim: The objectives where to compare convalescence data (fatigue, sleep, time to resume normal activities, and functional capabilities) and need for nursing care and contact to general practitioner with fast-track multi-modal rehabilitation compared with conventional car...
Published on Mar 1, 2004in Diseases of The Colon & Rectum4.09
Linda Basse11
Estimated H-index: 11
(UCPH: University of Copenhagen),
Jens Erik Thorbøl1
Estimated H-index: 1
+ 1 AuthorsHenrik Kehlet105
Estimated H-index: 105
(UCPH: University of Copenhagen)
BACKGROUND:For patients undergoing colonic surgery, the postoperative hospital stay is usually 6 to 10 days, and the morbidity rate is 15 to 20 percent. Fast-track rehabilitation programs have reduced the hospital stay to 2 to 3 days. The aim of this study was to evaluate the postoperative outcome a
Cited By95
Newest
Published on Dec 1, 2019in Journal of Surgical Research1.87
Michael L. Boisen2
Estimated H-index: 2
(University of Pittsburgh),
Alexandra J. McQuaid (University of Pittsburgh)+ 5 AuthorsKathirvel Subramaniam11
Estimated H-index: 11
(University of Pittsburgh)
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...
Published on Jan 1, 2019in Frontiers in Oncology
Yang Cao (HUM: Hubei University of Medicine), Hui-Yun Gu (WHU: Wuhan University)+ 5 AuthorsYan Fu1
Estimated H-index: 1
(HUM: Hubei University of Medicine)
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. Met...
Published on Mar 1, 2019in Scandinavian Journal of Surgery1.53
Caroline Williamsson4
Estimated H-index: 4
(Lund University),
T. Karlsson (Lund University)+ 3 AuthorsBobby Tingstedt18
Estimated H-index: 18
(Lund University)
Background: Enhanced recovery program for pancreaticoduodenectomy have become standard care. Little is known about adherence rates and sustainability of the program, especially when pancreaticogastrostomy is used in reconstruction. The aim of this study was, therefore, to evaluate adherence rates and continued outcome, after implementation of an enhanced recovery program. Methods: Consecutive patients undergoing pancreaticoduodenectomy at the Department of Surgery, Skane University Hospital, Lun...
Published on Jan 1, 2019in Journal of Surgical Research1.87
Emily McCracken2
Estimated H-index: 2
(Duke University),
Leila Mureebe20
Estimated H-index: 20
(Duke University),
Dan G. Blazer106
Estimated H-index: 106
(Duke University)
Abstract Background Pancreaticoduodenectomy (PD) incurs a surgical site infection rate of up to 18%. Published rates after minimally invasive PD are comparable or superior to open, but data are limited to high-volume, single-institution series. This study aimed to determine national outcomes. We hypothesized nationwide infections would be reduced with a minimally invasive approach. Materials and methods Using the newly available pancreatectomy-specific outcomes in National Surgical Quality Impro...
Published on Nov 1, 2018in Surgery3.48
Luca Gianotti43
Estimated H-index: 43
(University of Milan),
Marc G. Besselink33
Estimated H-index: 33
(UvA: University of Amsterdam)
+ 33 AuthorsPascal Probst9
Estimated H-index: 9
(Heidelberg University)
Background The optimal nutritional therapy in the field of pancreatic surgery is still debated. Methods An international panel of recognized pancreatic surgeons and pancreatologists decided that the topic of nutritional support was of importance in pancreatic surgery. Thus, they reviewed the best contemporary literature and worked to develop a position paper to provide evidence supporting the integration of appropriate nutritional support into the overall management of patients undergoing pancre...
Published on Nov 1, 2018in Surgery3.48
Filip Čečka6
Estimated H-index: 6
,
Bohumil Jon3
Estimated H-index: 3
+ 3 AuthorsMartin Lovecek5
Estimated H-index: 5
Abstract Background This dual-center, randomized controlled trial aimed to compare 2 types of intra-abdominal drains after pancreatic resection and their effect on the development of pancreatic fistulae and postoperative complications. Methods Patients undergoing pancreatic resection were randomized to receive either a closed-suction drain or a closed, passive gravity drain. The primary endpoint was the rate of postoperative pancreatic fistula. A secondary endpoint was postoperative morbidity du...
Published on Oct 1, 2018in Journal of Gastrointestinal Surgery2.69
Vandana Agarwal3
Estimated H-index: 3
,
Martin Jose Thomas (Westmead Hospital)+ 6 AuthorsShailesh V. Shrikhande30
Estimated H-index: 30
Background Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery.
Published on Jan 1, 2018
Vikram Kate12
Estimated H-index: 12
(JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research),
Mohsina Subair1
Estimated H-index: 1
(JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research)
+ 1 AuthorsN. Ananthakrishnan5
Estimated H-index: 5
(Mahatma Gandhi Medical College & Research Institute)
Surgery is a cause of stress, the intensity of which depends on the procedure. Despite a better understanding of the sequence of events leading to the physiological stress response, there has not been any major change in the perioperative care of patients. Perioperative care is often based on the age old so-called inviolable principles [1]. Elements of perioperative care such as prolonged use of drains, forced bed rest, graduated diets, etc. were deemed essential and were taught to successive ge...
Published on Sep 1, 2017in Molecular and Clinical Oncology
Hongwei Zhang10
Estimated H-index: 10
(Fourth Military Medical University),
Li Sun17
Estimated H-index: 17
(Fourth Military Medical University)
+ 2 AuthorsGuo‑Cai Li1
Estimated H-index: 1
(Fourth Military Medical University)
The aim of the present study was to evaluate the safety of gastrectomy without nasogastric and nutritional intubations. Between January 2010 and August 2015, 74 patients with gastric cancer received total gastric resection and esophagogastric anastomosis without nasogastric and nutritional intubations at the First Department of Digestive Surgery of the XiJing Hospital of Digestive Diseases (Xi'an, China), of whom 42 were also received earlier oral feeding within 48 h. The data were retrospective...