TY - JOUR
T1 - Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy
T2 - A randomized controlled trial
AU - Takagi, Kosei
AU - Yoshida, Ryuichi
AU - Yagi, Takahito
AU - Umeda, Yuzo
AU - Nobuoka, Daisuke
AU - Kuise, Takashi
AU - Hinotsu, shiro
AU - Matsusaki, Takashi
AU - Morimatsu, Hiroshi
AU - Eguchi, Jun
AU - Wada, Jun
AU - Senda, Masuo
AU - Fujiwara, Toshiyoshi
N1 - Funding Information:
A special thanks to the staffs of the Departments of Gastroenterological Surgery, Anesthesiology and Resuscitology, Nephrology, Rheumatology, Endocrinology and Metabolism, Rehabilitation Medicine, Clinical Nutrition, and the Center for Innovative Clinical Medicine, and the nurses on the wards, operating rooms, and intensive care units without whose support this study would not have been possible. We also express our gratitude to Kenichi Shikata, Kenji Iwai, Ayako Noguchi, Yuko Hasegawa, and Tae Yamanishi for their continuing involvement in this study., The abstract was selected for presentation as an ESPEN 2017 Annual Congress Paper of Excellence. The authors thank the ESPEN Scientific Committee.
Publisher Copyright:
© 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism
PY - 2019/2
Y1 - 2019/2
N2 - Background & aims: Evidence of the advantages of enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) is limited. The aim of this study was to examine the efficiency of ERAS protocols in patients following PD. Methods: Between June 2014 and October 2016, patients undergoing PD were randomly assigned to receive ERAS protocols or standard care. The primary endpoint was the postoperative length of stay. Secondary endpoints included postoperative complications, postoperative quality-of-life (QoR-40J), readmission, and medical cost. Results: Of 80 eligible patients, 74 were analyzed in intention-to-treat principles: 37 in the control group and 37 in the ERAS group. The mean length of stay in the ERAS group was significantly shorter than that in the control group (20.1 ± 5.4 vs 26.9 ± 13.5 days, P < 0.001). The ERAS group had a significantly lower percentage of postoperative complications (32.4% vs 56.8%, P = 0.034) and readmissions (0% vs 8.1%, P = 0.038). Quality-of-life was also significantly better in the ERAS group (184 ± 12.4 vs 177 ± 14.5, P = 0.022). The total medical cost was lower in the ERAS group, but not significantly ($25,445 ± 5065 vs $28,384 ± 9999, P = 0.085). Conclusions: The optimization of ERAS protocols in patients undergoing PD is safe and accelerates perioperative recovery and quality-of-life, thereby reducing the length of stay. Morbidity was significantly decreased in the ERAS group without compromising surgical outcome. Registration number: UMIN000014068.
AB - Background & aims: Evidence of the advantages of enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) is limited. The aim of this study was to examine the efficiency of ERAS protocols in patients following PD. Methods: Between June 2014 and October 2016, patients undergoing PD were randomly assigned to receive ERAS protocols or standard care. The primary endpoint was the postoperative length of stay. Secondary endpoints included postoperative complications, postoperative quality-of-life (QoR-40J), readmission, and medical cost. Results: Of 80 eligible patients, 74 were analyzed in intention-to-treat principles: 37 in the control group and 37 in the ERAS group. The mean length of stay in the ERAS group was significantly shorter than that in the control group (20.1 ± 5.4 vs 26.9 ± 13.5 days, P < 0.001). The ERAS group had a significantly lower percentage of postoperative complications (32.4% vs 56.8%, P = 0.034) and readmissions (0% vs 8.1%, P = 0.038). Quality-of-life was also significantly better in the ERAS group (184 ± 12.4 vs 177 ± 14.5, P = 0.022). The total medical cost was lower in the ERAS group, but not significantly ($25,445 ± 5065 vs $28,384 ± 9999, P = 0.085). Conclusions: The optimization of ERAS protocols in patients undergoing PD is safe and accelerates perioperative recovery and quality-of-life, thereby reducing the length of stay. Morbidity was significantly decreased in the ERAS group without compromising surgical outcome. Registration number: UMIN000014068.
KW - Enhanced recovery after surgery
KW - Goal-directed-therapy
KW - Pancreaticoduodenectomy
KW - Postoperative outcomes
KW - Randomized
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U2 - 10.1016/j.clnu.2018.01.002
DO - 10.1016/j.clnu.2018.01.002
M3 - Article
C2 - 29373148
AN - SCOPUS:85040547768
SN - 0261-5614
VL - 38
SP - 174
EP - 181
JO - Clinical Nutrition
JF - Clinical Nutrition
IS - 1
ER -