Division of GI Surgery, GI Oncology, Minimal Access and Bariatric Surgery, Institute of Digestive and Hepatobiliary Sciences, Medanta - the Medicity, Sector 38, Gurugram, Haryana, 122001, India.
Bapuji Dental College and Hospital, Davangere, Karnataka, 577004, India.
Langenbecks Arch Surg. 2021 Jun;406(4):1093-1101. doi: 10.1007/s00423-021-02108-w. Epub 2021 Mar 27.
With the proven benefits of enhanced recovery protocols (ERP) after pancreatoduodenectomy (PD), their implementation has become a well-accepted clinical practice across the major pancreatic surgery centres of the world. The impact of age on the execution of ERP has remained an area of ambiguity. The aim of this study was to assess the impact of age on the feasibility of various postoperative elements of ERP after PD.
A retrospective study was conducted which included 548 patients undergoing PD, managed using ERP, from March 2013 to September 2020. Patients were divided into two groups: < 70 years and ≥ 70 years. Compliance to recovery parameters and postoperative outcomes, including, the incidence of major complications, length of stay (LOS), mortality rates and re-admissions, were compared between the two groups. The impact of age, as a continuous variable, was also studied on the feasibility of each postoperative element.
One-fifth (113/548) of the cohort comprised of patients aged 70 years and above. The 'elderly' patients had a significantly higher prevalence of diabetes, hypertension, and cardiac disease. They were also more likely to get admitted to the intensive care unit for postoperative monitoring (p < 0.001). The median LOS was 8.0 days in the young and 9.0 days in the elderly (p = 0.253). Rate of major complications (age < 70, n = 37 (8.5%) vs age ≥ 70, n = 7 (6.2%), p = 0.421) and 30-day mortality (age < 70, n = 15 (3.4%) vs age ≥ 70, n = 7 (6.2%), p = 0.185) was not statistically different between the two groups. Compliance of various postoperative elements was similar between the two groups. When studied as a continuous variable, age did not seem to be associated with higher non-compliance of any of the postoperative recovery elements.
Age is not a barrier in the safe implementation of postoperative element of ERPs after PD. Enhanced recovery protocols do not need to be modified for the aged.
增强恢复方案（ERP）在胰十二指肠切除术后（PD）的益处已得到证实，因此其在世界各大胰腺外科中心的实施已成为一种公认的临床实践。年龄对 ERP 执行的影响一直是一个存在争议的领域。本研究旨在评估年龄对 PD 后 ERP 各种术后元素可行性的影响。
回顾性研究纳入 2013 年 3 月至 2020 年 9 月期间接受 PD 并采用 ERP 治疗的 548 例患者。患者分为两组：<70 岁和≥70 岁。比较两组之间恢复参数和术后结果（包括主要并发症的发生率、住院时间（LOS）、死亡率和再入院率）的依从性。还研究了年龄作为连续变量对每个术后元素的可行性的影响。
548 例患者中有五分之一（113/548）年龄在 70 岁及以上。“老年”患者糖尿病、高血压和心脏病的患病率明显较高。他们也更有可能因术后监测而被收治到重症监护病房（p<0.001）。年轻患者的中位 LOS 为 8.0 天，老年患者为 9.0 天（p=0.253）。主要并发症发生率（年龄<70 岁，n=37（8.5%）与年龄≥70 岁，n=7（6.2%），p=0.421）和 30 天死亡率（年龄<70 岁，n=15（3.4%）与年龄≥70 岁，n=7（6.2%），p=0.185）在两组之间无统计学差异。两组之间各种术后元素的依从性相似。当作为连续变量进行研究时，年龄似乎与任何术后恢复元素的更高不依从性无关。
年龄不是 PD 后 ERP 术后元素安全实施的障碍。增强恢复方案不需要针对老年人进行修改。
