Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis
(2024) In Journal of Hepato-Biliary-Pancreatic Sciences- Abstract
Background: This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD). Methods: Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age-dependent effect, the group was divided in septuagenarians (70–79 years) and older patients (≥80 years). Results: IPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major... (More)
Background: This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD). Methods: Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age-dependent effect, the group was divided in septuagenarians (70–79 years) and older patients (≥80 years). Results: IPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major complication rates were comparable in both groups (OR 0.92 [95% CI: 0.65–1.29], p =.596 and OR 1.22 [95% CI: 0.61–2.46], p =.508). Length of hospital stay tended to be shorter in the ERAS group compared to the conventional care group (−0.14 days [95% CI: −0.29 to 0.01], p =.071) while readmission rates were comparable and the total length of stay including days in hospital after readmission tended to be shorter in the ERAS group (−0.28 days [95% CI: −0.62 to 0.05], p =.069). In the subgroups, the length of stay was shorter in octogenarians treated with ERAS (−0.36 days [95% CI: −0.71 to −0.004], p =.048). The readmission rate increased slightly but not significantly while the total length of stay was not longer in the ERAS group. Conclusion: ERAS in the elderly is safe and its benefits are preserved in the care of even in patients older than 80 years. Standardized care protocol should be encouraged in all pancreatic centers.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- aged, enhanced recovery after surgery, meta-analysis, pancreatoduodenectomy, perioperative care
- in
- Journal of Hepato-Biliary-Pancreatic Sciences
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:38282543
- scopus:85183857659
- ISSN
- 1868-6974
- DOI
- 10.1002/jhbp.1417
- language
- English
- LU publication?
- yes
- id
- 1f167921-a84b-4aa4-9660-0da7502d836a
- date added to LUP
- 2024-02-27 13:24:33
- date last changed
- 2024-06-07 21:15:33
@article{1f167921-a84b-4aa4-9660-0da7502d836a,
abstract = {{<p>Background: This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD). Methods: Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age-dependent effect, the group was divided in septuagenarians (70–79 years) and older patients (≥80 years). Results: IPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major complication rates were comparable in both groups (OR 0.92 [95% CI: 0.65–1.29], p =.596 and OR 1.22 [95% CI: 0.61–2.46], p =.508). Length of hospital stay tended to be shorter in the ERAS group compared to the conventional care group (−0.14 days [95% CI: −0.29 to 0.01], p =.071) while readmission rates were comparable and the total length of stay including days in hospital after readmission tended to be shorter in the ERAS group (−0.28 days [95% CI: −0.62 to 0.05], p =.069). In the subgroups, the length of stay was shorter in octogenarians treated with ERAS (−0.36 days [95% CI: −0.71 to −0.004], p =.048). The readmission rate increased slightly but not significantly while the total length of stay was not longer in the ERAS group. Conclusion: ERAS in the elderly is safe and its benefits are preserved in the care of even in patients older than 80 years. Standardized care protocol should be encouraged in all pancreatic centers.</p>}},
author = {{Kuemmerli, Christoph and Balzano, Gianpaolo and Bouwense, Stefan A. and Braga, Marco and Coolsen, Mariëlle and Daniel, Sara K. and Dervenis, Christos and Falconi, Massimo and Hwang, Dae Wook and Kagedan, Daniel J. and Kim, Song Cheol and Lavu, Harish and Nussbaum, Daniel and Partelli, Stefano and Passeri, Michael J. and Pecorelli, Nicolò and Pillarisetty, Venu G. and Pucci, Michael J. and Sutcliffe, Robert P. and Tingstedt, Bobby and van der Kolk, Marion and Vrochides, Dionisios and Armstrong, Misha and Wei, Alice and Williamsson, Caroline and Yeo, Charles J. and Zani, Sabino and Zouros, Efstratios and Rozzini, Renzo and Abu Hilal, Mohammed}},
issn = {{1868-6974}},
keywords = {{aged; enhanced recovery after surgery; meta-analysis; pancreatoduodenectomy; perioperative care}},
language = {{eng}},
publisher = {{Wiley-Blackwell}},
series = {{Journal of Hepato-Biliary-Pancreatic Sciences}},
title = {{Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis}},
url = {{http://dx.doi.org/10.1002/jhbp.1417}},
doi = {{10.1002/jhbp.1417}},
year = {{2024}},
}