Department of Surgical Gastroenterology, SK Hospital, Thiruvananthapuram, India.
Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India.
HPB (Oxford). 2022 Mar;24(3):309-321. doi: 10.1016/j.hpb.2021.11.004. Epub 2021 Nov 12.
Clinical pathways (CP) based on Enhanced recovery after surgery (ERAS®) are increasingly utilised in patients undergoing pancreatoduodenectomy (PD). This systematic review aimed to compare the impact of CPs versus conventional care (CC) on peri-PD costs.
A systematic review of major reference databases was undertaken. Quality assessment was performed using the CHEERS checklist. Incremental cost-effectiveness ratios were calculated as part of the cost-effectiveness analysis. A meta-analysis was performed using random-effects models and Trial sequential analysis (TSA) was used to assess the precision and conclusiveness of the results.
14 studies meeting inclusion criteria were included for full qualitative synthesis. All studies reported a reduction in overall costs, length of stay and overall complication rates for CPs when compared to CC. Meta-analysis performed on nine studies demonstrated significantly reduced costs in the CP group, with considerable heterogeneity (Pooled mean difference of $ 4.28 × 10, p < 0.01, I = 95%). Cost-effectiveness analysis in relation to complications demonstrated dominance of CPs over CC in being cheaper as well as more effective. TSA supported the cost benefit of enhanced-recovery CPs, displaying minimal type 1 error.
Peri-PD CPs result in significant cost-reduction in comparison to CC.
基于术后加速康复（ERAS®）的临床路径（CP）越来越多地用于接受胰十二指肠切除术（PD）的患者。本系统评价旨在比较 CP 与常规护理（CC）对 PD 围手术期成本的影响。
对主要参考数据库进行系统评价。使用 CHEERS 清单进行质量评估。作为成本效益分析的一部分，计算增量成本效益比。使用随机效应模型进行荟萃分析，并使用试验序贯分析（TSA）评估结果的精度和结论性。
纳入了 14 项符合纳入标准的研究进行全面定性综合分析。与 CC 相比，所有研究均报告 CP 可降低总费用、住院时间和总体并发症发生率。对 9 项研究进行的荟萃分析表明 CP 组的成本显著降低，存在很大的异质性（CP 组的 pooled mean difference 为$4.28×10，p<0.01，I=95%）。与并发症相关的成本效益分析表明，CP 在更便宜的同时也更有效，因此优于 CC。TSA 支持增强型康复 CP 的成本效益，显示出最小的一类错误。
与 CC 相比，PD 围手术期 CP 可显著降低成本。
