Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
HPB (Oxford). 2022 Jan;24(1):65-71. doi: 10.1016/j.hpb.2021.05.014. Epub 2021 Jun 16.
BACKGROUND/PURPOSE: There is no data regarding the impact of enhanced recovery pathways (ERP) on composite length of stay (CLOS) after procedures with increased risk of morbidity and mortality, such as pancreaticoduodenectomy.
Patients undergoing open pancreaticoduodenectomy before and after implementation of ERP were prospectively followed for 90 days after surgery and complications were severity graded using the Modified Accordion Grading System. A retrospective analysis of patient outcomes were compared before and after instituting ERP. 1:1 propensity score matching was used to compare ERP patient outcomes to those of matched pre-ERP patients. CLOS is defined as postoperative length of hospital stay (PLOS) plus readmission length of hospital stay within 90 days after surgery.
494 patients underwent open pancreaticoduodenectomy - 359 pre-ERP and 135 ERP. In a 1:1 propensity-score-matched analysis of 110 matched pairs, ERP patients had significantly decreased superficial surgical site infections (5.5% vs 15.5% p = 0.015) and significantly increased rates of urinary retention (29.1% vs 7.3% p < 0.0001) compared to matched pre-ERP patients. However, overall complication rate and 90-day readmission rate were not significantly different between matched groups. Propensity score-matched ERP patients had significantly decreased PLOS (7 days vs 8 days p = 0.046) compared to matched pre-ERP patients, but CLOS was not significantly different (9 days vs 9.5 days p = 0.615).
ERP may reduce PLOS but might not impact the total postoperative time spent in the hospital (i.e. CLOS) within 90 days after pancreaticoduodenectomy.
背景/目的：在胰腺十二指肠切除术等发病率和死亡率较高的手术中，尚无关于强化康复路径（ERP）对复合住院时间（CLOS）影响的数据。
前瞻性随访接受开放胰腺十二指肠切除术的患者，在 ERP 实施前后 90 天内进行手术，并使用改良 Accordion 分级系统对并发症严重程度进行分级。对实施 ERP 前后患者的治疗结果进行回顾性分析。使用 1:1 倾向评分匹配比较 ERP 患者与匹配的 ERP 前患者的治疗结果。CLOS 定义为术后住院时间（PLOS）加术后 90 天内再次住院的住院时间。
494 例患者接受了开放胰腺十二指肠切除术 - 359 例 ERP 前和 135 例 ERP。在 110 对 1:1 倾向评分匹配的分析中，与匹配的 ERP 前患者相比，ERP 患者的浅表手术部位感染发生率显著降低（5.5% vs 15.5%，p=0.015），尿潴留发生率显著增加（29.1% vs 7.3%，p<0.0001）。然而，两组之间的总体并发症发生率和 90 天再入院率没有显著差异。与匹配的 ERP 前患者相比，ERP 患者的 PLOS 明显缩短（7 天 vs 8 天，p=0.046），但 CLOS 无显著差异（9 天 vs 9.5 天，p=0.615）。
ERP 可能会缩短 PLOS，但可能不会影响胰腺十二指肠切除术后 90 天内总住院时间（即 CLOS）。
