Partelli S, Crippa S, Castagnani R, Ruffo G, Marmorale C, Franconi A M, De Angelis C, Falconi M
Departement of Surgery and Anesthesiology, Università Politecnica delle Marche, Ancona, Italy.
Department of Surgery, Ospedale "Sacro Cuore-Don Calabria", Negrar, Italy.
HPB (Oxford). 2016 Feb;18(2):153-158. doi: 10.1016/j.hpb.2015.09.009. Epub 2015 Dec 10.
Recent evidence has shown that enhanced recovery after surgery (ERAS) protocols decrease hospital stay following pancreaticoduodenectomy (PD). The aims of this study were to assess the feasibility and to evaluate the effect of introducing ERAS principles after PD in elderly patients.
Patients ≥75 years were defined as elderly. Comparison of postoperative outcome was performed between 22 elderly patients who underwent ERAS (elderly ERAS + patients) and a historical cohort of 66 elderly patients who underwent standard protocols (elderly ERAS-patients).
The lowest adherence with ERAS among elderly patients was observed for starting a solid food diet within POD 4 (n = 7) and early drains removal (n = 2). The highest adherence was observed for post-operative glycemic control (n = 21), epidural analgesia (n = 21), mobilization (n = 20) and naso-gastric removal in POD 0 (n = 20). Post-operative outcomes did not differ between elderly ERAS+ and elderly ERAS- patients. In patients with an uneventful postoperative course, the median intention to discharge was earlier in elderly ERAS + patients as compared to the elderly ERAS- patients (4 days versus 8 days, P < 0.001).
An ERAS protocol following PD seems to be feasible and safe among elderly although it is not associated with improved postoperative outcomes.
近期证据表明，术后加速康复（ERAS）方案可缩短胰十二指肠切除术（PD）后的住院时间。本研究旨在评估在老年患者中实施PD术后ERAS原则的可行性并评价其效果。
将年龄≥75岁的患者定义为老年患者。对22例接受ERAS的老年患者（老年ERAS+组患者）与66例接受标准方案的老年患者历史队列（老年ERAS-组患者）的术后结局进行比较。
老年患者中，术后第4天内开始固体食物饮食（n=7）和早期拔除引流管（n=2）的ERAS依从性最低。术后血糖控制（n=21）、硬膜外镇痛（n=21）、活动（n=20）和术后第0天拔除鼻胃管（n=20）的依从性最高。老年ERAS+组和老年ERAS-组患者的术后结局无差异。在术后过程平稳的患者中，老年ERAS+组患者的中位出院意向较老年ERAS-组患者更早（4天对8天，P<0.001）。
PD术后的ERAS方案在老年患者中似乎可行且安全，尽管它与术后结局改善无关。
