University of Washington Department of Surgery, Seattle, WA, United States of America.
PLoS One. 2018 Dec 28;13(12):e0209608. doi: 10.1371/journal.pone.0209608. eCollection 2018.
Pancreaticoduodenectomy is a complex surgical procedure associated with high morbidity and prolonged length of stay. Enhanced recovery after surgery principles have reduced complications rate and length of stay for multiple types of operations. We hypothesized that implementation of a standardized perioperative care pathway would facilitate safe discharge by five days after pancreaticoduodenectomy.
We performed a retrospective cohort study of patients undergoing pancreaticoduodenectomy 18 months prior to and 18 months following implementation of a perioperative care pathway at a quaternary center performing high volume pancreatic surgery.
A total of 145 patients underwent pancreaticoduodenectomy (mean age 63 ± 10 years, 52% female), 81 before and 64 following pathway implementation, and the groups were similar in terms of preoperative comorbidities. The percentage of patients discharged within 5 days of surgery increased from 36% to 64% following pathway implementation (p = 0.001), with no observed differences in post-operative serious adverse events (p = 0.34), pancreatic fistula grade B or C (p = 0.28 and p = 0.27 respectively), or delayed gastric emptying (p = 0.46). Multivariate regression analysis showed length of stay ≤5 days three times more likely after pathway implementation. Rates of readmission within 30 days (20% pre- vs. 22% post-pathway (p = 0.75)) and 90 days (27% pre- vs. 36% post-pathway (p = 0.27)) were unchanged after pathway implementation, and were no different between patients discharged before or after day 5 at both 30 days (19% ≤5 days vs. 23% ≥ 6 days (p = 0.68)) and 90 days (32% ≤5 days vs. 30% ≥ 6 days (p = 0.81)).
Standardizing perioperative care via enhanced recovery protocols for patients undergoing pancreaticoduodenectomy facilitates safe discharge by post-operative day five.
胰十二指肠切除术是一种复杂的手术，与高发病率和住院时间延长有关。术后恢复增强原则降低了多种手术的并发症发生率和住院时间。我们假设实施标准化围手术期护理路径将有助于在胰十二指肠切除术后 5 天安全出院。
我们对一家四级中心进行了回顾性队列研究，该中心在实施围手术期护理路径前 18 个月和实施后 18 个月内对胰十二指肠切除术患者进行了研究。
共有 145 名患者接受了胰十二指肠切除术（平均年龄 63 ± 10 岁，52%为女性），81 名患者在实施路径前，64 名患者在实施路径后，两组患者术前合并症相似。手术后 5 天内出院的患者比例从实施路径前的 36%增加到 64%（p = 0.001），术后严重不良事件无差异（p = 0.34），胰瘘 B 级或 C 级（p = 0.28 和 p = 0.27）或胃排空延迟（p = 0.46）。多变量回归分析显示，实施路径后，住院时间≤5 天的可能性增加了三倍。30 天内再入院率（实施路径前为 20%，实施路径后为 22%（p = 0.75））和 90 天内再入院率（实施路径前为 27%，实施路径后为 36%（p = 0.27））在实施路径后没有改变，在 30 天（5 天内≤5 天的患者为 19%，5-6 天的患者为 23%（p = 0.68））和 90 天（5 天内≤5 天的患者为 32%，5-6 天的患者为 30%（p = 0.81）），出院前或后 5 天出院的患者之间没有差异。
通过增强恢复方案对接受胰十二指肠切除术的患者进行标准化围手术期护理，可以在术后第 5 天安全出院。
