Abstract
We created a novel, preoperative wellness program (WP) that promotes recovery. This study assessed its impact on patient outcomes after pancreatectomy. Pancreatoduodenectomies (PD) and distal pancreatectomies (DP) performed from 2015 to 2018 were reviewed using our institutional NSQIP database. Patients in the WP had their medical conditions optimized and were provided with the following: chlorhexidine, topical mupirocin, incentive spirometer, and immune-nutrition supplements. Out of a total of 669 pancreatectomy patients (411 PD, 258 DP), 308 were enrolled in the WP (188 PD, 120 DP). In the PD subgroup, on multivariable analysis (MVA), the WP patients had shorter lengths of hospital stay (LOS) (12 vs. 10 days, p<0.001). On MVA, WP patients had less post-op transfusion (20 vs. 10%, p=0.027). For the combined groups on MVA, LOS continued to be significant (OR=0.89, 95%CI=0.82-0.97, p<0.007). A preoperative patient centered WP may reduce the length of stay.
Highlights
The wellness program (WP) consists of a visit to the preadmission testing (PAT) Clinic where acute/chronic medical conditions are identified, and referrals are made for testing or to medical subspecialty clinics where indicated
A prospective trial and metaanalysis with 3,700 pancreatectomy patients reported improved patient outcomes and/or decreased length of stay with implementation of Enhanced recovery after surgery (ERAS) protocol focused on early alimentation, drain removal, and minimization of narcotics and intravenous fluids [23,24,25,26,27]
The effect of the WP has been previously established on a large scale across multiple surgical specialties at our institution; implementation was associated with a reduction in post-operative complications such as SSIs, among patients with ASA score of 3 or higher [28]
Summary
The safety profile of PD has dramatically improved with high-volume centers reporting morbidity rates of 40-60% and mortality rates of 2-4% [2,3,4]. SSI is the most common surgical complication, with an incidence of 2-5% following inpatient operations [6], and up to 28% following complex gastrointestinal procedures [3,4,5]. SSIs are thought to be preventable in up to 60% of cases with adherence to current guidelines [6, 8, 9] These include the use of surgical clippers, chlorhexidine scrub, preoperative antibiotics, and nutritional optimization. Poor nutritional status is associated with increased post-operative complications, poor wound healing and decreased functional quality of life [13]. The objective of this study was to assess the impact of the WP on patient outcomes following pancreatic resection
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