Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis

Christoph Kuemmerli; Christoph Tschuor; Meidai Kasai; Adnan A Alseidi; Gianpaolo Balzano; Stefan Bouwense; Marco Braga; Mariëlle Coolsen; Sara K Daniel; Christos Dervenis; Massimo Falconi; Dae Wook Hwang; Daniel J Kagedan; Song Cheol Kim; Harish Lavu; Tingbo Liang; Daniel Nussbaum; Stefano Partelli; Michael J Passeri; Nicolò Pecorelli; Sastha Ahanatha Pillai; Venu G Pillarisetty; Michael J Pucci; Wei Su; Robert P Sutcliffe; Bobby Tingstedt; Marion van der Kolk; Dionisios Vrochides; Alice Wei; Caroline Williamsson; Charles J Yeo; Sabino Zani; Efstratios Zouros; Mohammed Abu Hilal

doi:10.1093/bjs/znab436

Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis

Christoph Kuemmerli, Christoph Tschuor, Meidai Kasai, Adnan A Alseidi, Gianpaolo Balzano, Stefan Bouwense, Marco Braga, Mariëlle Coolsen, Sara K Daniel, Christos Dervenis, Massimo Falconi, Dae Wook Hwang, Daniel J Kagedan, Song Cheol Kim, Harish Lavu, Tingbo Liang, Daniel Nussbaum, Stefano Partelli, Michael J Passeri, Nicolò PecorelliSastha Ahanatha Pillai, Venu G Pillarisetty, Michael J Pucci, Wei Su, Robert P Sutcliffe, Bobby Tingstedt, Marion van der Kolk, Dionisios Vrochides, Alice Wei, Caroline Williamsson, Charles J Yeo, Sabino Zani, Efstratios Zouros, Mohammed Abu Hilal

Abstract

BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy.

METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission.

RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate.

CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.

Originalsprog	Engelsk
Tidsskrift	The British journal of surgery
Vol/bind	109
Udgave nummer	3
Sider (fra-til)	256-266
Antal sider	11
ISSN	0007-1323
DOI	https://doi.org/10.1093/bjs/znab436
Status	Udgivet - 24 feb. 2022

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Kuemmerli, C., Tschuor, C., Kasai, M., Alseidi, A. A., Balzano, G., Bouwense, S., Braga, M., Coolsen, M., Daniel, S. K., Dervenis, C., Falconi, M., Hwang, D. W., Kagedan, D. J., Kim, S. C., Lavu, H., Liang, T., Nussbaum, D., Partelli, S., Passeri, M. J., ... Abu Hilal, M. (2022). Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis. The British journal of surgery, 109(3), 256-266. https://doi.org/10.1093/bjs/znab436

Kuemmerli, C, Tschuor, C, Kasai, M, Alseidi, AA, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, SK, Dervenis, C, Falconi, M, Hwang, DW, Kagedan, DJ, Kim, SC, Lavu, H, Liang, T, Nussbaum, D, Partelli, S, Passeri, MJ, Pecorelli, N, Pillai, SA, Pillarisetty, VG, Pucci, MJ, Su, W, Sutcliffe, RP, Tingstedt, B, van der Kolk, M, Vrochides, D, Wei, A, Williamsson, C, Yeo, CJ, Zani, S, Zouros, E & Abu Hilal, M 2022, 'Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis', The British journal of surgery, bind 109, nr. 3, s. 256-266. https://doi.org/10.1093/bjs/znab436

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title = "Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis",

abstract = "BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy.METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission.RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate.CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.",

keywords = "Enhanced Recovery After Surgery, Humans, Length of Stay, Pancreaticoduodenectomy/adverse effects, Patient Readmission, Postoperative Complications/prevention & control, Recovery of Function",

author = "Christoph Kuemmerli and Christoph Tschuor and Meidai Kasai and Alseidi, {Adnan A} and Gianpaolo Balzano and Stefan Bouwense and Marco Braga and Mari{\"e}lle Coolsen and Daniel, {Sara K} and Christos Dervenis and Massimo Falconi and Hwang, {Dae Wook} and Kagedan, {Daniel J} and Kim, {Song Cheol} and Harish Lavu and Tingbo Liang and Daniel Nussbaum and Stefano Partelli and Passeri, {Michael J} and Nicol{\`o} Pecorelli and Pillai, {Sastha Ahanatha} and Pillarisetty, {Venu G} and Pucci, {Michael J} and Wei Su and Sutcliffe, {Robert P} and Bobby Tingstedt and {van der Kolk}, Marion and Dionisios Vrochides and Alice Wei and Caroline Williamsson and Yeo, {Charles J} and Sabino Zani and Efstratios Zouros and {Abu Hilal}, Mohammed",

year = "2022",

month = feb,

day = "24",

doi = "10.1093/bjs/znab436",

language = "English",

volume = "109",

pages = "256--266",

journal = "The British journal of surgery",

issn = "0007-1323",

publisher = "John/Wiley & Sons Ltd",

number = "3",

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TY - JOUR

T1 - Impact of enhanced recovery protocols after pancreatoduodenectomy

T2 - meta-analysis

AU - Kuemmerli, Christoph

AU - Tschuor, Christoph

AU - Kasai, Meidai

AU - Alseidi, Adnan A

AU - Balzano, Gianpaolo

AU - Bouwense, Stefan

AU - Braga, Marco

AU - Coolsen, Mariëlle

AU - Daniel, Sara K

AU - Dervenis, Christos

AU - Falconi, Massimo

AU - Hwang, Dae Wook

AU - Kagedan, Daniel J

AU - Kim, Song Cheol

AU - Lavu, Harish

AU - Liang, Tingbo

AU - Nussbaum, Daniel

AU - Partelli, Stefano

AU - Passeri, Michael J

AU - Pecorelli, Nicolò

AU - Pillai, Sastha Ahanatha

AU - Pillarisetty, Venu G

AU - Pucci, Michael J

AU - Su, Wei

AU - Sutcliffe, Robert P

AU - Tingstedt, Bobby

AU - van der Kolk, Marion

AU - Vrochides, Dionisios

AU - Wei, Alice

AU - Williamsson, Caroline

AU - Yeo, Charles J

AU - Zani, Sabino

AU - Zouros, Efstratios

AU - Abu Hilal, Mohammed

PY - 2022/2/24

Y1 - 2022/2/24

N2 - BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy.METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission.RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate.CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.

AB - BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy.METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission.RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate.CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.

KW - Enhanced Recovery After Surgery

KW - Humans

KW - Length of Stay

KW - Pancreaticoduodenectomy/adverse effects

KW - Patient Readmission

KW - Postoperative Complications/prevention & control

KW - Recovery of Function

UR - http://www.scopus.com/inward/record.url?scp=85125211750&partnerID=8YFLogxK

U2 - 10.1093/bjs/znab436

DO - 10.1093/bjs/znab436

M3 - Review

C2 - 35037019

SN - 0007-1323

VL - 109

SP - 256

EP - 266

JO - The British journal of surgery

JF - The British journal of surgery

IS - 3

ER -

Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis

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