Department of Surgery, Medical University of South Carolina, 171 Ashley Ave., 96 Jonathan Lucas Street, Charleston, SC, 29425, USA.
World J Surg. 2022 Nov;46(11):2760-2768. doi: 10.1007/s00268-022-06676-w. Epub 2022 Jul 27.
We evaluated the effect of an Enhanced Recovery After Surgery protocol on intraoperative fluid administration and postoperative outcomes in pancreatic surgery.
Pancreatic cancer resections at our institution from 2012 to 2018 were grouped according to pre- or post-protocol initiation. Preoperative characteristics and postoperative outcomes were compared with Fisher's exact test and chi-square for categorical variables, and Mann-Whitney U test for continuous variables. Further analysis separated patients that had a Whipple from those who had distal pancreatectomy.
A total of 263 patients underwent pancreatic cancer resection during the study period (169 Whipples, 84 DPs, 92 pre-ERAS and 171 post-ERAS). Intraoperative fluid administration significantly decreased after protocol implementation (mean 6,277 ml vs. 3870 ml, p < 0.001). This held true when separating patients that had a Whipple procedure from those that had a DP (6,929 ml vs. 4,513 ml, p < 0.001, 5,060 ml vs. 2,833 cc, p = 0.002, respectively). Intensive care unit (ICU) admission (41.3% vs. 20.5%, p < 0.001) and length of stay (9.4 vs. 8.1 days, p < 0.01) were significantly reduced after ERAS implementation for all patients and in Whipple patients alone (47.5% vs. 23.6%, p = 0.002 and 10.7 vs. 6.6 days, p = 0.004). DP patients also had significantly decreased ICU admissions (41.3% vs. 20.5%, p = 0.045). All other postoperative outcomes were not significantly different.
For patients undergoing pancreatic cancer resection, goal-directed fluid management is associated with decreased intraoperative fluid administration, decreased ICU admission, and decreased length of stay without an increase in postoperative complications or readmission.
我们评估了术后快速康复方案对胰腺手术术中液体管理和术后结局的影响。
根据方案实施前后将我院 2012 年至 2018 年的胰腺肿瘤切除术患者进行分组。采用 Fisher 确切检验和卡方检验比较分类变量，Mann-Whitney U 检验比较连续变量，比较术前特征和术后结局。进一步分析将行胰十二指肠切除术的患者与行胰体尾切除术的患者分开。
研究期间共有 263 例患者接受胰腺肿瘤切除术（胰十二指肠切除术 169 例，胰体尾切除术 84 例，ERAS 前组 92 例，ERAS 后组 171 例）。方案实施后术中液体输注显著减少（平均 6277ml 比 3870ml，p<0.001）。这在分别比较行胰十二指肠切除术和胰体尾切除术的患者时仍然成立（分别为 6929ml 比 4513ml，p<0.001，5060ml 比 2833cc，p=0.002）。所有患者和仅行胰十二指肠切除术的患者中，术后入住重症监护病房（ICU）（41.3%比 20.5%，p<0.001）和住院时间（9.4 天比 8.1 天，p<0.01）显著减少，而仅行胰体尾切除术的患者中，术后入住 ICU（47.5%比 23.6%，p=0.002）和住院时间（10.7 天比 6.6 天，p=0.004）也显著减少。胰体尾切除术患者 ICU 入住率也显著降低（41.3%比 20.5%，p=0.045）。其他术后结局均无显著差异。
对于行胰腺肿瘤切除术的患者，目标导向性液体管理与术中液体输注减少、ICU 入住率降低、住院时间缩短相关，且不增加术后并发症或再入院率。
