Ritter Alina S, Welsch Thilo, Brodersen Freya, Auinger Julia, Moll-Khosrawi Parisa, Goetz Mara R, Bardenhagen Jan, Nitschke Christine, Schneider Tobias, Wellge Björn, Suling Anna, Uzunoglu Faik G, Heumann Asmus, Nickel Felix, Hackert Thilo, Izbicki Jakob R
From the Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Ann Surg Open. 2024 Nov 25;5(4):e501. doi: 10.1097/AS9.0000000000000501. eCollection 2024 Dec.
The aim was to evaluate the sustainability of the pancreatic Enhanced Recovery After Surgery (ERAS) program and the effect of ERAS items on patient morbidity and hospital stay.
The current ERAS guideline recommendations encompass 27 items to improve recovery after pancreatoduodenectomy (PD).
Patients who underwent pancreatic resection at the University Hospital Hamburg-Eppendorf between February 2016 and June 2023 were included. The datasets were retrospectively collected from a central database. The effects of individual ERAS items and compliance on morbidity and hospital stay were assessed by uni- and multivariable analyses.
In total, 594 patients who underwent PD (44.8%), distal pancreatectomy (14.6%), total pancreatectomy (17.8%), or other pancreatic resections (22.7%) were included. Of these, 90 patients (15.2%) achieved a high overall ERAS compliance of ≥70%. High compliance was associated with significantly less complications (Clavien-Dindo ≥ 3a), reduced 30-day mortality, and a shorter hospital stay. Early mobilization on the first postoperative day (POD1), restrictive intravenous fluid administration, and timely removal of urinary catheters were significant multivariable predictors for lower morbidity. Early mobilization on POD1 also correlated with reduced morbidity in the subcohort of PD cases.
The pancreatic ERAS protocol can be sustainably implemented and applied to both, PD and non-PD cases. A high level of compliance with the ERAS protocol after pancreatic resections correlated with improved outcomes but was achieved by less than one-fifth of patients. Early mobilization on POD1 and restrictive fluid management were key indicators for optimized short-term outcomes.
旨在评估胰腺手术后加速康复（ERAS）计划的可持续性以及ERAS项目对患者发病率和住院时间的影响。
当前的ERAS指南建议包含27项内容，以改善胰十二指肠切除术（PD）后的恢复情况。
纳入2016年2月至2023年6月在汉堡-埃彭多夫大学医院接受胰腺切除术的患者。数据集从中央数据库中进行回顾性收集。通过单变量和多变量分析评估各个ERAS项目及其依从性对发病率和住院时间的影响。
总共纳入了594例行PD（44.8%）、远端胰腺切除术（14.6%）、全胰腺切除术（17.8%）或其他胰腺切除术（22.7%）的患者。其中，90例患者（15.2%）实现了≥70%的高总体ERAS依从性。高依从性与显著更少的并发症（Clavien-Dindo≥3a）、降低的30天死亡率以及更短的住院时间相关。术后第1天（POD1）早期活动、限制性静脉输液以及及时拔除尿管是较低发病率的重要多变量预测因素。POD1早期活动在PD病例亚组中也与发病率降低相关。
胰腺ERAS方案可以可持续地实施并应用于PD和非PD病例。胰腺切除术后对ERAS方案的高依从性与改善的结果相关，但只有不到五分之一的患者达到这一水平。POD1早期活动和限制性液体管理是优化短期结果的关键指标。
