Examination of post-operative complication having influence on prolonged hospital stay after sub-total stomach-preserving pancreaticoduodenectomy (SSpPD)

Abstract

Patients & methods: Major medical and scientific public databases were searched for studies comparing ERAS protocols with standard postoperative management following PD, published between January 2000 and March 2015. A Meta-analysis was conducted comparing post-operative hospital stay, morbidity and mortality as well as rates of pancreatic fistula (PF), delayed gastric emptying (DGE), readmission and reoperation. Pooled odds ratios (OR) or weighted mean differences (WMD) were calculated as appropriate. Results: 11 non-randomized comparative studies including a total of 2453 patients were analyzed. Implementation of an ERAS protocol was associated with shorter postoperative hospital stays (WMD: -4.41 days; 95% CI: -6.31, -2.52, P<0.00001), less DGE (OR: 0.59; 95% CI: 0.46, 0.75, P<0.0001) and lower overall morbidity (OR: 0.63; 95% CI: 0.53, 0.75, P<0.00001) compared to conventional care. There were no statistically significant differences in rates of PF, mortality, readmission or reoperation between the two approaches. Conclusion: Use of an ERAS protocol following PD is associated with shorter postoperative hospital stays as well as lower rates of DGE and overall morbidity without affecting PF, reoperation, readmission or mortality rates. General adoption of ERAS protocols after PD is recommended.