World Journal of Surgery

, Volume 37, Issue 8, pp 1909–1918 | Cite as

Systematic Review and Meta-analysis of Enhanced Recovery After Pancreatic Surgery with Particular Emphasis on Pancreaticoduodenectomies

  • M. M. E. Coolsen
  • R. M. van Dam
  • A. A. van der Wilt
  • K. Slim
  • K. Lassen
  • C. H. C. Dejong
Article

Abstract

Background

In the past decade, Enhanced Recovery after Surgery (ERAS) protocols have been implemented in several fields of surgery. With these protocols, a faster recovery and shorter hospital stay can be accomplished without an increase in morbidity or mortality. The purpose of this study was to review systematically the evidence for implementation of an ERAS protocol in pancreatic resections, with particular emphasis on pancreaticoduodenectomies (PDs).

Methods

A systematic search was performed in Medline, Embase, Pubmed, CINAHL, and the Cochrane library for papers describing an ERAS program in adult patients undergoing elective pancreatic surgery published between January 1966 and December 2012. The primary outcome measure was postoperative length of stay. Secondary outcome measures were time to recovery of normal function, overall postoperative complication rates, readmissions, and mortality. Subsequently, a meta-analysis of outcome measures focusing on PD was conducted. This systematic review and meta-analysis was performed according to the PRISMA statement.

Results

The literature search produced 248 potentially relevant papers. Of these, eight papers met the predefined inclusion criteria: five case-control studies, two retrospective studies, and one prospective study, describing a total of 1,558 patients. Only three of the studies reported data on discharge criteria and assessed time to recovery and return to normal function. Implementation of an ERAS protocol led in four of five comparative studies to a significant decrease in length of stay (reduction of 2–6 days in different studies). Meta-analysis of four studies focusing on PDs showed that there was a significant difference in complication rates in favor of the ERAS group (absolute risk difference 8.2 %, 95 % confidence interval (CI) 2.0–14.4, p = 0.008). Introduction of an ERAS protocol did not result in an increase in mortality or readmissions. Delayed gastric emptying and incidence of pancreatic fistula did not differ significantly between groups. All studies reporting on hospital costs showed a decrease after implementation of ERAS.

Conclusions

This systematic review suggests that using an ERAS protocol in pancreatic resections may help to shorten hospital length of stay without compromising morbidity and mortality. This seemed to apply to distal pancreatectomy, total pancreatectomy, and PD. Meta-analysis was performed for those studies focusing on PD and showed that there were no differences in readmission or mortality. Morbidity rates were significantly lower for patients managed according ERAS principles.

Keywords

Pancreatic Fistula Distal Pancreatectomy Pancreatic Resection Delay Gastric Emptying Total Pancreatectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This systematic review and meta-analysis was not funded.

Conflict of interest

The authors report no conflict of interest.

Supplementary material

268_2013_2044_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)

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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • M. M. E. Coolsen
    • 1
  • R. M. van Dam
    • 1
  • A. A. van der Wilt
    • 1
  • K. Slim
    • 3
  • K. Lassen
    • 4
    • 5
    • 6
  • C. H. C. Dejong
    • 1
    • 2
  1. 1.Department of SurgeryUniversity Hospital MaastrichtMaastrichtThe Netherlands
  2. 2.NUTRIM School for Nutrition, Toxicology and MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
  3. 3.Department of General and Digestive SurgeryCHU EstaingClermont-FerrandFrance
  4. 4.Department of Gastrointestinal SurgeryUniversity Hospital Northern NorwayTromsøNorway
  5. 5.Institute of Clinical MedicineUniversity of TromsøTromsøNorway
  6. 6.Clinical and Surgical Sciences (Surgery)Royal InfirmaryEdinburghUK

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