Application value of enhanced recovery after surgery in the pancreatic surgery

Abstract

Objective To evaluate the feasibility and safety of enhanced recovery after surgery (ERAS) in the pancreatic surgery. Methods The retrospective case-control study was adopted. The clinical data of 135 patients who underwent pancreatic surgery at the First Affiliated Hospital of Nanjing Medical University from October 2014 to March 2015 were collected. Forty-seven patients receiving ERAS management between January 2015 and March 2015 were allocated into the ERAS group and 88 patients receiving traditional perioperative management between October 2014 and December 2014 were allocated into the control group. Observation indicators included (1) postoperative clinical indexes: time for initial water intake, time for out-of-bed activity, time to initial defecation, time of gastric tube removal, time of urinary catheter removal, time of abdominal drainage-tube removal, duration of hospital stay, duration of hospital stay of patients without complications and hospital expenses, (2) postoperative complications: pancreatic fistula, delayed gastric emptying, bleeding, biliary fistula, chyle leakage, intra-abdominal infection, reoperation rate, mortality, incidence of complications and readmission rate within 90 days. The follow-up using telephone interview and outpatient examination was performed to detect postoperative recovery and further treatment of patients up to July 1, 2016. Measurement data with normal distribution were presented as ±s and analyzed by t test. Count data were analyzed by the chi-square test. Results (1) Postoperative clinical indexes: time for initial water intake, time for out-of-bed activity, time of urinary catheter removal and duration of hospital stay were (20±5)hours, (53±11)hours, (2.2±1.3)days, (15.6±8.2)days in the ERAS group and (25±3)hours, (59±8)hours, (3.8±1.7)days, (20.0±13.8)days in the control group, respectively, with statistically significant differences between the 2 groups (t=7.00, 3.75, 5.63, 2.00, P 0.05). There was no occurrence of death and reoperation in the ERAS group, 2 patients had readmission due to peritoneal effusion, and 2, 1 and 1 patients were respectively complicated with abdominal bleeding, intra-abdominal infection and chyle leakage. There was no occurrence of reoperation in the control group and 1 patient died of abdominal bleeding, and 5, 4, 3, and 1 patients were respectively complicated with intra-abdominal infection, bleeding, biliary fistula and chyle leakage as well as 1 patient received reoperation due to abdominal bleeding. The incidences of pancreatic fistula in grade B/C and delayed gastric emptying in grade B/C were 10.6%(5/47), 8.5%(4/47) in the ERAS group and 22.7%(20/88), 4.5%(4/88)in the control group, showing no statistically significant difference in the pancreatic fistula and delayed gastric emptying between the 2 groups (χ2=2.97, 0.86, P>0.05). Conclusion The perioperative ERAS program in the pancreatic surgery is safe and effective and should be popularized, meanwhile, it can also reduce duration of hospital stay and improve the quality of life and satisfaction of patients. Key words: Pancreatic surgery; Enhanced recovery after surgery; Perioperative period