Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Department of Hepatobiliary and Pancreatic Surgery, the Second Affliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
Hepatobiliary Pancreat Dis Int. 2020 Feb;19(1):51-57. doi: 10.1016/j.hbpd.2019.09.006. Epub 2019 Sep 13.
The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care program aimed at reducing surgical stress response and accelerating recovery. However, a small proportion of patients fail to benefit from the ERAS program following pancreaticoduodenectomy. This study aimed to identify the risk factors associated with failure of ERAS program in pancreaticoduodenectomy.
Between May 2014 and December 2017, 176 patients were managed with ERAS program following pancreaticoduodenectomy. ERAS failure was indicated by prolonged hospital stay, unplanned readmission or unplanned reoperation. Demographics, postoperative recovery and compliance were compared of those ERAS failure groups to the ERAS success group.
ERAS failure occurred in 59 patients, 33 of whom had prolonged hospital stay, 18 were readmitted to hospital within 30 days after discharge, and 8 accepted reoperation. Preoperative American Society of Anesthesiologists (ASA) score of ≥III (OR = 2.736; 95% CI: 1.276-6.939; P = 0.028) and albumin (ALB) level of <35 g/L (OR = 3.589; 95% CI: 1.403-9.181; P = 0.008) were independent risk factors associated with prolonged hospital stay. Elderly patients (>70 years) were on a high risk of unplanned reoperation (62.5% vs. 23.1%, P = 0.026). Patients with prolonged hospital stay and unplanned reoperation had delayed intake and increased intolerance of oral foods. Prolonged stay patients got off bed later than ERAS success patients did (65 h vs. 46 h, P = 0.012). Unplanned reoperation patients tended to experience severer pain than ERAS success patients did (3 score vs. 2 score, P = 0.035).
Patients with high ASA score, low ALB level or age >70 years were at high risk of ERAS failure in pancreaticoduodenectomy. These preoperative demographic and clinical characteristics are important determinants to obtain successful postoperative recovery in ERAS program.
加速康复外科（ERAS）方案是一种基于证据的围手术期护理方案，旨在减轻手术应激反应并加速康复。然而，一小部分接受胰十二指肠切除术的患者并未从 ERAS 方案中获益。本研究旨在确定与胰十二指肠切除术后 ERAS 方案失败相关的危险因素。
2014 年 5 月至 2017 年 12 月，176 例患者接受 ERAS 方案治疗胰十二指肠切除术。ERAS 失败的标准为住院时间延长、计划外再入院或计划外再次手术。比较 ERAS 失败组与 ERAS 成功组的人口统计学、术后恢复和依从性。
59 例患者 ERAS 失败，其中 33 例住院时间延长，18 例出院后 30 天内再入院，8 例接受再次手术。术前美国麻醉医师协会（ASA）评分≥III 级（OR=2.736；95%CI：1.276-6.939；P=0.028）和白蛋白（ALB）水平<35g/L（OR=3.589；95%CI：1.403-9.181；P=0.008）是与住院时间延长相关的独立危险因素。老年患者（>70 岁）计划外再次手术风险较高（62.5%比 23.1%，P=0.026）。住院时间延长和计划外再次手术的患者延迟进食和增加口服食物不耐受。住院时间延长的患者下床时间晚于 ERAS 成功患者（65h 比 46h，P=0.012）。计划外再次手术的患者疼痛程度较 ERAS 成功患者严重（3 分比 2 分，P=0.035）。
ASA 评分高、ALB 水平低或年龄>70 岁的患者在胰十二指肠切除术后 ERAS 方案失败的风险较高。这些术前人口统计学和临床特征是获得 ERAS 方案成功术后恢复的重要决定因素。
