HealthResJ, health, medicine, nursing, research https://ejournals.epublishing.ekt.gr/index.php/HealthResJ/sitemap

Clinical outcomes of Enhanced Recovery after Surgery Protocol for Hepato- pancreato- biliary Surgery; A Five-Year Experience from a Hellenic Oncological Hospital ERAS protocol and HPB surgery


Published: Jul 7, 2022
Keywords:
cost-effectiveness eras program fast track protocol liver and pancreatic surgery
Maria Kapritsou
https://orcid.org/0000-0002-8187-4978
Evan Alexandrou
https://orcid.org/0000-0001-7428-872X
Evangelos A Konstantinou
Margarita Giannakopoulou
Nikolaos Fyrfiris
Dimitrios P Korkolis
Abstract

Background: The development of enhanced recovery after surgery protocols (ERAS) for surgical intervention has contributed to reducing hospital length of stay and improved patient outcomes. Aim of the study was the assessment of the recovery time and cost-effectiveness of an ERAS protocol in oncological patients undergoing hepato- pancreato- biliary surgery (HPB) compared to conventional (CON) care.

Methods: This prospective, open label, randomized trial, enrolled 283 patients who required hepatectomy or pancreatoduodenectomy. Eligible patients were stratified into hepatectomy or pancreatectomy groups then, randomly assigned to ERAS protocol (intervention) or CON care (control). The primary outcome of interest was post-operative recovery time (composite of; time to mobilization and oral intake) and secondary outcomes were cost effectiveness, dependance on post-operative opioids and post-operative complications (using the Clavien- Dindo classification).

Results: The rate of complications for the patients underwent hepatectomy and treated in ERAS group was 18.18% compared to CON group, which was 40.9%. Whilst, of complications for the patients underwent pancreatectomy and treated in ERAS group was 15.94% compared to CON group, which was 38.2%.

Conclusions: The ERAS protocol in this study significantly improved post-operative recovery time, reduced opioid dependance and reduced post-operative complications in patients undergoing HPB surgery.

 

 

Article Details
  • Section
  • Original Articles
Downloads
Download data is not yet available.
References
Steele SR, Bleier J, Champagne B, Hassan I, Russ A, Senagore AJ, et al. Improving Outcomes and Cost-Effectiveness of Colorectal Surgery. J Gastrointest Surg. 2014;18(11):1944–56.
Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ. 2001;322(7284):473–6.
Kehlet H. ERAS Implementation—Time To Move For-ward. Ann Surg [Internet]. 2018;XX(Xx):1. Available from: http://insights.ovid.com/crossref?an=00000658-900000000-95711
Wewers ME, Lowe NK. Wewers_et_al-1990-Research_in_Nursing_&_Health. 1990;227–36.
Pablo AJ, Julián EJ, Sofía AA, Paola S-Z. Colombian Journal of Anesthesiology Analysis of results after the implementation of fast recovery protocols in hepato-pancreatobiliary surgery Análisis de resultados después de la implementación de protocolos de recu-peración acelerada en cirugía hepatopanc. 2018;46(58):196–201.
Spelt L, Ansari D, Sturesson C, Tingstedt B, Andersson R. Fast-track programmes for hepatopancreatic resec-tions: Where do we stand? Hpb. 2011;13(12):833–8.
Bongers BC, Dejong CHC, Dulk M den. Enhanced re-covery after surgery programmes in older patients un-dergoing hepatopancreatobiliary surgery: What bene-fits might prehabilitation have? Eur J Surg Oncol [In-ternet]. 2020;(xxxx). Available from: http://www.sciencedirect.com/science/article/pii/S074879832030370X
Relph S, Bell A, Sivashanmugarajan V, Munro K, Chig-widden K, Lloyd S, et al. Cost effectiveness of en-hanced recovery after surgery programme for vaginal hysterectomy: A comparison of pre and post-implementation expenditures. Int J Health Plann Man-age. 2014;29(4):399–406.
Zouros E, Liakakos T, MacHairas A, Patapis P, Agalian-os C, Dervenis C. Improvement of gastric emptying by enhanced recovery after pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int [Internet]. 2016;15(2):198–208. Available from: http://dx.doi.org/10.1016/S1499-3872(16)60061-9
Guan X, Liu L, Lei X, Zu X, Li Y, Chen M, et al. A com-parative study of fast-track verus conventional surgery in patients undergoing laparoscopic radical cystecto-my and ileal conduit diversion: Chinese experience. Sci Rep [Internet]. 2014;4:6820. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?ar-tid=4212226&tool=pmcentrez&rendertype=abstract
Siotos C, Stergios K, Naska A, Frountzas M, Pergialiotis V, Perrea DN, et al. The impact of fast track protocols in upper gastrointestinal surgery: A meta-analysis of observational studies. Surgeon. 2018 Jun;16(3):183–92.
Chen S, Zou Z, Chen F, Huang Z, Li G. A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy. Ann R Coll Surg Engl. 2015 Jan;97(1):3–10.
Lei Q, Wang X, Tan S, Xia X, Zheng H, Wu C. Fast-track programs versus traditional care in hepatectomy: a meta-analysis of randomized controlled trials. Dig Surg. 2014;31(4–5):392–9.
Lillemoe HA, Aloia TA. Enhanced Recovery After Sur-gery: Hepatobiliary. Surg Clin North Am. 2018 Dec;98(6):1251–64.
Sakowska M, Docherty E, Linscott D, Connor S. A change in practice from epidural to intrathecal mor-phine analgesia for hepato-pancreato-biliary surgery. World J Surg. 2009 Sep;33(9):1802–8.
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010 Jul;1(2):100–7.
Petrou S, Gray A. Economic evaluation alongside ran-domised controlled trials: design, conduct, analysis, and reporting. BMJ. 2011 Apr;342:d1548.
[World Medical Association (AMM). Helsinki Declara-tion. Ethical principles for medical research involving human subjects]. Assist Inferm Ric. 2001;20(2):104–7.
Morales Soriano R, Esteve Pérez N, Tejada Gavela S, Cuadrado García Á, Rodríguez Pino JC, Morón Canis JM, et al. Outcomes of an enhanced recovery after surgery programme for pancreaticoduodenectomy. Cirugía española [Internet]. 2015;93(8):509–15. Avail-able from: http://www.ncbi.nlm.nih.gov/pubmed/26072690
Blind P-J, Andersson B, Tingstedt B, Bergenfeldt M, Andersson R, Lindell G, et al. Fast-track program for liver resection--factors prolonging length of stay. Hepatogastroenterology. 2014;61(136):2340–4.
Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce AA, Di Carlo V. Fast-track recovery programme after pancreaticoduodenectomy reduces delayed gastric emptying. Br J Surg. 2008;95(11):1387–93.
Montiel Casado MC, Pardo S??nchez F, Rotellar Sastre F, Mart?? Cruchaga P, ??lvarez Cienfuegos FJ. Experi-encia de un programa de fast-track en la duode-nopancreatectom??a cef??lica. Cir Esp. 2010;87(6):378–84.
Berberat PO, Ingold H, Gulbinas A, Kleeff J, M??ller MW, Gutt C, et al. Fast track-different implications in pancreatic surgery. J Gastrointest Surg. 2007;11(7):880–7.
Di Sebastiano P, Festa L, De Bonis A, Ciuffreda A, Val-vano MR, Andriulli A, et al. A modified fast-track pro-gram for pancreatic surgery: A prospective single-center experience. Langenbeck’s Arch Surg. 2011;396(3):345–51.
Abu Hilal M, Di Fabio F, Badran A, Alsaati H, Clarke H, Fecher I, et al. Implementation of enhanced recovery programme after pancreatoduodenectomy: A single-centre UK pilot study. Pancreatology [Internet]. 2012;13(1):58–62. Available from: http://dx.doi.org/10.1016/j.pan.2012.11.312
Ratti F, Cipriani F, Reineke R, Comotti L, Paganelli M, Catena M, et al. The clinical and biological impacts of the implementation of fast-track perioperative pro-grams in complex liver resections: A propensity score-based analysis between the open and laparoscopic approaches. Surg (United States) [Internet]. 2018;164(3):395–403. Available from: https://doi.org/10.1016/j.surg.2018.04.020
Qi S, Chen G, Cao P, Hu J, He G, Luo J, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A pro-spective randomized controlled trial. J Clin Lab Anal. 2018;32(6):1–8.
Chong CCN, Chung WY, Cheung YS, Fung AKY, Fong AKW, Lok HT, et al. Enhanced recovery after surgery for liver resection. 2019;1–8.
Perinel J, Duclos A, Payet C, Bouffard Y, Lifante JC, Ad-ham M. Impact of enhanced recovery program after surgery in patients undergoing pancreatectomy on postoperative outcomes: A controlled before and after study. Dig Surg. 2019;
Kowalsky SJ, Zenati MS, Steve J, Esper SA, Lee KK, Hogg ME, et al. A Combination of Robotic Approach and ERAS Pathway Optimizes Outcomes and Cost for Pancreatoduodenectomy. Ann Surg. 2019;269(6):1138–45.
Wu S-J, Xiong X-Z, Lu J, Cheng Y, Lin Y-X, Zhou R-X, et al. Fast-Track Programs for Liver Surgery: A Meta-Analysis. J Gastrointest Surg [Internet]. 2015;19(9):1640–52. Available from: http://link.springer.com/10.1007/s11605-015-2879-z
Dai J, Jiang Y, Fu D. Reducing postoperative complica-tions and improving clinical outcome: Enhanced re-covery after surgery in pancreaticoduodenectomy – A retrospective cohort study. Int J Surg [Internet]. 2017;39:176–81. Available from: http://dx.doi.org/10.1016/j.ijsu.2017.01.089
Jing X, Zhang B, Xing S, Tian L, Wang X, Zhou M, et al. Cost-benefit analysis of enhanced recovery after hepa-tectomy in Chinese Han population. Med (United States). 2018;97(34).
Ovaere S, Boscart I, Parmentier I, Steelant PJ, Gabriel T, Allewaert J, et al. The Effectiveness of a Clinical Path-way in Liver Surgery: a Case-Control Study. J Gastroin-test Surg. 2018;22(4):684–94.
Joliat GR, Labgaa I, Petermann D, Hübner M, Griesser AC, Demartines N, et al. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduode-nectomy. Br J Surg. 2015;1676–83.
Most read articles by the same author(s)