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Impact of enhanced recovery protocols after pancreatoduodenectomy : meta-analysis

Kuemmerli, Christoph ; Tschuor, Christoph ; Kasai, Meidai ; Alseidi, Adnan A. ; Balzano, Gianpaolo ; Bouwense, Stefan ; Braga, Marco ; Coolsen, Mariëlle ; Daniel, Sara K. and Dervenis, Christos , et al. (2022) In The British journal of surgery 109(3). p.256-266
Abstract

BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD)... (More)

BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate. CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The British journal of surgery
volume
109
issue
3
pages
11 pages
publisher
Oxford University Press
external identifiers
  • pmid:35037019
  • scopus:85125211750
ISSN
1365-2168
DOI
10.1093/bjs/znab436
language
English
LU publication?
yes
id
d04d1418-ae4e-4b30-8563-3524b1c632e8
date added to LUP
2022-05-02 10:42:03
date last changed
2024-06-14 14:52:43
@article{d04d1418-ae4e-4b30-8563-3524b1c632e8,
  abstract     = {{<p>BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P &lt; 0.001) and solid (-3.84 (-5.09 to -2.60) days; P &lt; 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P &lt; 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P &lt; 0.001) without a higher readmission rate. CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.</p>}},
  author       = {{Kuemmerli, Christoph and Tschuor, Christoph and Kasai, Meidai and Alseidi, Adnan A. and Balzano, Gianpaolo and Bouwense, Stefan 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 Liang, Tingbo and Nussbaum, Daniel and Partelli, Stefano and Passeri, Michael J. and Pecorelli, Nicolò and Pillai, Sastha Ahanatha and Pillarisetty, Venu G. and Pucci, Michael J. and Su, Wei and Sutcliffe, Robert P. and Tingstedt, Bobby and van der Kolk, Marion and Vrochides, Dionisios and Wei, Alice and Williamsson, Caroline and Yeo, Charles J. and Zani, Sabino and Zouros, Efstratios and Abu Hilal, Mohammed}},
  issn         = {{1365-2168}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{256--266}},
  publisher    = {{Oxford University Press}},
  series       = {{The British journal of surgery}},
  title        = {{Impact of enhanced recovery protocols after pancreatoduodenectomy : meta-analysis}},
  url          = {{http://dx.doi.org/10.1093/bjs/znab436}},
  doi          = {{10.1093/bjs/znab436}},
  volume       = {{109}},
  year         = {{2022}},
}