Pancreatic Surgery Patients Research Articles

The Effect of Case Management Model on the Application of Pancreatic Cancer Surgery Patients and the Recovery of Gastrointestinal Function

Objective: To evaluate the effect of the case management model on patients operated for pancreatic cancer. Methods: 90 pancreatic cancer surgery patients admitted to the hospital between January 2022 and June 2023 were selected and grouped by randomized numerical table. For 45 cases in the observation group, case management mode was adopted, and for 45 cases in the intervention group, conventional nursing care was chosen to compare the indexes of gastrointestinal function recovery. Results: The recovery time of all gastrointestinal functions of the observation group was shorter than that of the intervention group; after nursing, the psychological state score of the observation group was lower than that of the intervention group, the self-efficacy score was higher than that of the intervention group and the rate of complications was lower than that of the intervention group (P < 0.05). Conclusion: The case management model can promote the recovery of gastrointestinal function in patients with pancreatic cancer surgery and its nursing feasibility is high.

EUS-guided pancreatic duct drainage: a single-center observational study

Background and aimsPancreatic duct obstruction can cause pain and atrophy of the pancreatic parenchyma. Endoscopic drainage is the first-line treatment, usually by endoscopic retrograde cholangiopancreatography. However, in some patients, the classic transpapillary approach cannot be performed because of anatomical inability to access the papilla, rupture of the main pancreatic duct, intracanal stones that cannot be crossed or tight stenosis of the main pancreatic duct due to extrinsic compression by parenchymal calcifications. Endoscopic ultrasound-guided pancreatic duct drainage is an efficient and minimally invasive therapeutic alternative for these patients. We aimed to evaluate clinical success of endoscopic ultrasound-guided pancreatic duct drainage in our center. MethodsData of patients who underwent endoscopic ultrasound-guided pancreatic duct drainage in our center between 2016 and 2022 were retrospectively reviewed. Clinical success was defined as pain ≤2 on the pain Visual Analog Scale (VAS, 0-10) and no recurrence of obstructive pancreatitis after successful stent placement. If the indication to the procedure was chronic pancreatitis with painless weight loss, then clinical success was defined as weight stabilization or weight regain after the procedure. Results46 patients (mean age 58 years old, 69.6% male) were included. Indications of endoscopic ultrasound-guided pancreatic duct drainage were chronic pancreatitis in 69.6% of patients (78.1% due to alcohol abuse). Other indications included post-operative complications, rupture of pancreatic duct and pancreatic cancer. Technical success was achieved in 93.5% of patients. 40 patients had pancreaticogastrostomy and 3 patients pancreaticoduodenostomy. The mean hospital stay was 2 days. Clinical success was 93% in patients who achieved technical success. Remaining pain on the VAS > 2 occurred in 9.3% of patients and obstructive pancreatitis recurrence in 6.9%. Adverse event occurred in 5 patients (11.6%). 18 stent dysfunctions were observed, 16 stent migrations and 2 stent obstructions. No patient died from the procedure. ConclusionEndoscopic ultrasound-guided pancreatic duct drainage showed a high clinical success rate. It is therefore a good minimally invasive alternative to avoid pancreatic surgery in patients with symptomatic pancreatic duct stenosis of benign or malignant etiology who failed endoscopic retrograde cholangiopancreatography.

Radiological classification of the Heidelberg triangle and its application in laparoscopic pancreaticoduodenectomy for malignancies

BackgroundThe TRIANGLE operation benefits patients with pancreatic cancer; however, the Heidelberg triangle, where the operation occurs, contains vessels that can impact safety, especially in laparoscopic pancreaticoduodenectomy (LPD) with the TRIANGLE operation. This study aimed to identify Heidelberg triangle vessel types and their implications in pancreaticoduodenectomy (PD).MethodsRetrospective collection of radiographic data was performed from January 2017 to April 2023. Three-dimensional (3D) CT reconstructions were performed on patients. Vascular types in the Heidelberg triangle were classified based on named vessels crossing its interior. The impact of these types on surgical outcomes and complications in PD with the TRIANGLE operation was assessed.ResultsPreoperative CT reconstruction was conducted on 184 pancreatic surgery patients. The findings revealed 99 patients (53.8%) with the type I Heidelberg triangle, lacking named vessels crossing the interior. Type II (n = 85, 46.2%), with named vessels crossing the interior, was identified. Among reconstructed patients who underwent PD with the TRIANGLE operation (n = 103), they were categorized as type I (n = 57) or type II (n = 46). The results showed that LPD patients with type II had significantly higher median intraoperative blood loss (300 mL vs. 200 mL, P = 0.030) and mean examined lymph nodes (17.2 ± 7.6 vs. 13.4 ± 5.2, P = 0.019) compared to those with type I. No significant differences were found in operative time or postoperative complications.ConclusionThe presence of named vessels crossing the interior of the Heidelberg triangle was associated with increased intraoperative bleeding during LPD combined with the TRIANGLE operation. Therefore, targeted preoperative planning is required before the operation, thus improving the safety of the TRIANGLE operation in minimally invasive surgery.

Surgical outcomes after pancreatic surgery in patients with a germline CDKN2A/p16 pathogenic variant under surveillance.

Surgical outcomes after pancreatic surgery in patients with a germline CDKN2A/p16 pathogenic variant under surveillance.

Antibiotic prophylaxis after 48 h postoperatively are not associated with decreased surgical site infections and other healthcare associated infections in pancreatic surgery patients: a retrospective cohort study

BackgroundIt is controversial whether antibiotic should be used prophylactically 48 h after pancreatic surgery. Hence, the association of antibiotic prophylaxis (AP) after 48 h postoperatively with the incidence of surgical site infections (SSIs) and other healthcare-associated infections (HAIs) in patients receiving pancreatic surgery was evaluated.MethodsA retrospective cohort analysis was performed on 1073 patients who underwent pancreatic surgery. These patients were categorized into the non-AP after 48 h postoperatively group (n = 963) and the AP after 48 h postoperatively group (n = 110) based on whether or not they obtained AP from 48 h to 30 days after surgery. Outcomes included SSIs and other HAIs.ResultsThe incidence of SSIs in the non-AP after 48 h postoperatively group (98/963, 10.2%) was notably lower than that in the AP after 48 h postoperatively group (22/110, 20.0%) (P = 0.002). Other HAIs incidence was not significantly different between the non-AP after 48 h postoperatively group (77/963, 8.0%) and the AP after 48 h postoperatively group (11/110, 10.0%) (P = 0.468). Multiple regression analysis demonstrated that AP after 48 h postoperatively was a risk factor for SSIs (OR = 2.14, 95% CI 1.28–3.59) but not for other HAIs (OR = 1.24, 95% CI 0.63–2.42) after adjustment for age, gender, and diabetes. Subsequent to adjustment for all confounding factors, AP after 48 h postoperatively was not a influence factor for SSIs (OR = 2.13, 95% CI 0.76–5.99) and other HAIs (OR = 3.69, 95% CI 0.99–13.81).ConclusionsAP after 48 h postoperatively following pancreatic surgery was not associated with the lower morbidity rate of SSIs and other HAIs. Nonetheless, this study may facilitate further development of strategies towards standardization of the duration of AP management of pancreatic surgery.

Usefulness of serum creatinine and cystatin C ratio as a screening tool for predicting prognosis in patients with pancreatic cancer.

This study aimed to evaluate the usefulness of the serum creatinine/cystatin C (Cr/CysC) ratio as a prognostic factor after pancreatic surgery in patients with pancreatic cancer. We retrospectively analyzed the data of 88 patients with pancreatic ductal carcinoma who underwent pancreatic surgery from January 2017 to December 2020. CysC measured from frozen serum samples and circulating Cr levels were used to calculate the Cr/CysC ratio. The cutoff value of the Cr/CysC ratio was determined using receiver operating characteristic curves. Cox proportional hazards model analysis and survival curves were applied to identify the prognostic factors. The optimal cutoff value of the Cr/CysC ratio for predicting mortality after surgery was 1.05. This study included 20 (22.7%) and 68 (77.3%) patients with high and low Cr/CysC ratios, respectively. The low Cr/CysC ratio was significantly associated with female sex (p=0.020) and higher levels of C-reactive protein (p=0.020). The postoperative length of stay was significantly longer in patients with low Cr/CysC rates (p=0.044). Patients with low Cr/CysC ratio showed poorer prognosis in relapse-free survival (hazard ratio [HR]=3.33; 95% confidence interval [CI]: 1.54-4.20; p=0.002) and overall survival (HR=2.52, 95% CI: 1.04-6.10, p=0.041), respectively, which were significantly worse than in those with high Cr/CysC ratios (p=0.003 and 0.049, respectively). The Cr/CysC ratio could be a useful screening tool for predicting the prognosis of patients with pancreatic ductal carcinoma undergoing pancreatic surgery.

A population-based nomogram to individualize treatment modality for pancreatic cancer patients underlying surgery

As the most aggressive tumor, TNM staging does not accurately identify patients with pancreatic cancer who are sensitive to therapy. This study aimed to identify associated risk factors and develop a nomogram to predict survival in pancreatic cancer surgery patients and to select the most appropriate comprehensive treatment regimen. First, the survival difference between radiotherapy and no radiotherapy was calculated based on propensity score matching (PSM). Cox regression was conducted to select the predictors of overall survival (OS). The model was constructed using seven variables: histologic type, grade, T stage, N stage, stage, chemotherapy and radiotherapy. All patients were classified into high- or low-risk groups based on the nomogram. The nomogram model for OS was established and showed good calibration and acceptable discrimination (C-index 0.721). Receiver operating characteristic curve (ROC) and DCA curves showed that nomograms had better predictive performance than TNM stage. Patients were divided into low-risk and high-risk groups according to nomogram scores. Radiotherapy is recommended for high-risk patients but not for low-risk patients. We have established a well-performing nomogram to effectively predict the prognosis of pancreatic cancer patients underlying surgery. The web version of the nomogram https://rockeric.shinyapps.io/DynNomapp/ may contribute to treatment optimization in clinical practice.

Short- and long-term outcomes of pancreatectomy in patients with hemodialysis.

Several reports have shown the high mortality rate of pancreatic resection in patients with hemodialysis (HD), however, its long-term outcome remains unclear. In this study, we examined cases of pancreatic resection in patients with HD and conducted a literature review. Four patients with HD who underwent pancreatic resection from 2004 to 2019 were enrolled. To compare the clinicopathological variables of HD and non-HD patients, 161 non-HD patients who had undergone surgical resection for pancreatic cancer were enrolled. Among four cases of pancreatic resection with HD, three cases were malignant diseases. All patients with HD had some co-morbidities (100% in HD group, 45.3% in the non-HD group) and postoperative complications (100% in the HD group, vs 46.6% in the non-HD group). Although one patient had severe postoperative complications and length of postoperative hospital stay was longer, the 30- and 90-day mortality rates were both 0% in patients with HD. However, three cases in the HD group (75%) died approximately 6 months after surgery, including one cancer-related death. Pancreatic surgery in patients with HD should be carefully indicated, especially pancreaticoduodenectomy or total pancreatectomy, because of the poor prognosis induced by non-cancer-related causes of death. J. Med. Invest. 70 : 105-109, February, 2023.

Shared Decision-Making in Pancreatic Surgery.

The objective of this study is to determine the factors influencing pancreatic surgery patients' perceptions of the shared decision-making process (SDM). Decision-making in pancreatic surgery is complicated by the risk of morbidity and mortality and risk of early recurrence of disease. Improvement in SDM has the potential to improve the receipt of goal- and value-concordant care. This cross-sectional survey included patients who underwent pancreatic surgery. The following components were studied in relation to SDM: modified satisfaction with decision scale (SWD), modified decisional regret scale (DRS), quality of physician and patient interaction, and the impact of quality of life (FACT-Hep). Correlations were computed using Pearson's correlation score and a regression model. The survey completion rate was 72.2% (of 40/55) and the majority (72.5%) of patients underwent pancreaticoduodenectomy. There were significant positive relationships between the SDM measure and (DRS, SWD; r = 0.70, P < 0.001) and responses to questions regarding how well the patient's actual recovery matched their expectations before treatment (r = 0.62, P < 0.001). The quality of the physician-patient relationship correlated with how well recovery matched expectations (r = 0.53, P = 0.002). SDM measure scores were significant predictors of the decision evaluation measure (R2(adj) = 0.48, P < 0.001), FACT-Hep (R2(adj) = 0.15, P < 0.001), and recovery expectations measure (R2(adj) = 0.37, P < 0.001). Improved SDM in pancreatic surgery is associated with more realistic recovery expectations, decreased decisional regret, and improved quality of life.

Impact of multicenter diagnostic workup on time-to-diagnosis and time-to-treatment in patients with pancreatic ductal adenocarcinoma: a nationwide analysis.

Background: Due to centralization of pancreatic surgery patients with suspected pancreatic cancer may undergo their diagnostic workup spread over a non-pancreatic expert center and a pancreatic expert center. This may cause delay in the diagnostic phase, repetition of diagnostic investigations, and eventually an increased time to initiate treatment. The aim of this study is to investigate how many patients suspected of pancreatic ductal adenocarcinoma (PDAC) have a multicenter diagnostic workup and to assess whether this is associated with a repetition of diagnostic investigations, a prolonged diagnostic phase and treatment delay.

Skeletal Muscle Loss after HPB Surgery and its Relation with Objectively Measured Postoperative Physical Activity and Nutritional Intake

Introduction: Although muscle loss is a well-known phenomenon in critical ill ICU-patients, little is known about muscle loss after major elective surgery and its association with in-hospital physical activity and nutritional intake. Methods: The MUSCLE POWER study is a prospective cohort study including patients undergoing major hepato-pancreato-biliary surgery. Postoperative muscle diameter was measured in six muscles (bilateral biceps, vastus intermedius, rectus femoris) by using ultrasound (Lumify, Philips) at baseline, three, seven and ten days after surgery. Physical activity and nutritional intake were objectively measured by Actigraph-device (wGT3X-BT) and a nutritional diary. Surgery-related muscle loss (SRML) was defined as >10% muscle loss in minimally one arm and one leg muscle. Results: Of the 111 included patients (67 (60%) men; mean age 66.11±11.65), 63 (57%) underwent pancreatic-, 43 (39%) liver- and 5 (4%) no-resection surgery. SRML after seven days was found in 41 (37%) patients. Patients with SRML had a higher median Comprehensive Complication Index (20.92 (8.66-27.61) versus 8.66 (0-25.86), p=0.029). Median activity in steps after four days was lower in patients with SRML (746 (358-1205) versus 1073 (519-2144) p=0.043). In pancreatic-surgery patients, significant lower protein intake per kilogram bodyweight was found in the SRML group at postoperative days two, three and five (p<0.05). In liver-surgery patients significant lower activity at postoperative days three and four was found (p<0.05) (Figure 1). Combination of lowest physical activity and lowest nutritional intake was highly related to SRML (p=0.004). Conclusion: Low postoperative physical activity and nutritional intake are associated with postoperative muscle loss.

Comparison of Short Term Surgical Outcomes According to Immediate Postoperative Serum Glucose Level in Non-Diabetic Pancreatic Resection Patients

Introduction: Regulation of postoperative blood glucose level has been shown better prognosis in many studies. However, impact of regulation of blood glucose level in major pancreatic surgery patients who were not diagnosed with diabetes is not established currently. The purpose of this study was to discuss the relevance of the immediate postoperative blood glucose level and short term postoperative outcomes of major pancreatic surgery in non-diabetic patients.

Enhanced recovery after pancreatic surgery: A prospective randomized controlled clinical trial.

The enhanced recovery after surgery (ERAS) protocol is a perioperative care bundle designed to achieve early healing after surgical procedures. This study aims to investigate the effect of the ERAS protocol on postoperative complications, length of hospital stay (LOS), and readmission rates in pancreatic surgery patients. The study was designed as a prospective and randomized controlled study between January 2016 and November 2018 on pancreatic surgery patients. A total of 38 patients were analyzed, 18 of whom were in the ERAS group and 20 in the control group. Patient demographics, intraoperative variables, and postoperative outcomes were recorded. The groups were similar regarding age, sex, surgery type, American Society of Anesthesiologists scores, and laboratory results. There was no significant difference in the intraoperative variables. Early oral feeding was preferred, mostly in the ERAS group compared to the control group. Perioperative complication rates, including delayed gastric emptying and pancreatic fistula, LOS, and readmission rates, were similar between the two groups. The ERAS protocol provided a minimal decrease in the total complication rates and had no effect on severe complications. Therefore, the ERAS protocol seems feasible and can be applied safely in pancreatic surgery patients.

Weight Loss Following Hepatopancreatobiliary Surgery. How Much is Too Much? A Retrospective Cohort Study.

Background & Aims. Postoperative weight loss is common following hepato-pancreato-biliary (HPB) surgical resections; however, the extent of weight loss and the association with poor outcomes have not been well described. We assessed the average percentage of weight loss and risk factors associated with sustained postoperative weight loss. Materials and Methods. We enrolled patients undergoing major HPB surgical resections from 2011–2016 at a single institution. We evaluated percent change in weight postoperatively, incidence of complications, and nutritional clinical markers at 1, 3, and 6 months postoperatively compared to preoperative baseline. We used multiple logistic regression to evaluate factors associated with significant weight loss (>10% from baseline) at 3 months from surgery. Results. Among 262 patients undergoing HPB surgery, liver surgery patients lost 2.5% of baseline weight at 3 months postoperatively but regained baseline weight by 6 months. Pancreatic surgery patients lost 7.7% at 3 months and were unable to recover their baseline weights at 6 months. Forty-three (16%) patients had major postoperative complications including abdominal abscess (5.3%) and anastomotic leak (3.8%). Patients who experienced major postoperative complications had a greater percentage weight loss at 3 months compared to those without major complications: median 11% (interquartile range (IQR): 7%–15%) vs 4% (IQR: 0%–8%), P < .001. In the multivariable analysis, major postoperative complications were associated with significant weight loss at 3 months (OR 3.39, 95% CI 1.38–8.33). Conclusions. Due to the association of weight loss and major postoperative complications, patients who experience significant weight loss (>10% from baseline) may benefit from nutritional assessment for dietary intervention.

Study Protocol of the PreFiPS Study: Prevention of Postoperative Pancreatic Fistula by Somatostatin Compared With Octreotide, a Prospective Randomized Controlled Trial.

Background: Pancreatic fistula (PF), i. e., a failure of the pancreatic anastomosis or closure of the remnant pancreas after distal pancreatectomy, is one of the most feared complications after pancreatic surgery. PF is also one of the most common complications after pancreatic surgery, occurring in about 30% of patients. Prevention of a PF is still a major challenge for surgeons, and various technical and pharmacological interventions have been investigated, with conflicting results. Pancreatic exocrine secretion has been proposed as one of the mechanisms by which PF occurs. Pharmacological prevention using somatostatin or its analogs to inhibit pancreatic exocrine secretion has shown promising results. We can hypothesize that continuous intravenous infusion of somatostatin-14, the natural peptide hormone, associated with 10–50 times stronger affinity with all somatostatin receptor compared with somatostatin analogs, will be associated with an improved PF prevention.Methods: A French comparative randomized open multicentric study comparing somatostatin vs. octreotide in adult patients undergoing pancreaticoduodenectomy (PD) or distal pancreatectomy with or without splenectomy. Patients with neoadjuvant radiation therapy and/or neoadjuvant chemotherapy within 4 weeks before surgery are excluded from the study. The main objective of this study is to compare 90-day grade B or C postoperative PF as defined by the last ISGPF (International Study Group on Pancreatic Fistula) classification between patients who receive perioperative somatostatin and octreotide. In addition, we analyze overall length of stay, readmission rate, cost-effectiveness, and postoperative quality of life after pancreatic surgery in patients undergoing PD.Conclusion: The PreFiPS study aims to evaluate somatostatin vs. octreotide for the prevention of postoperative PF.

Safety of Hepatobiliary and Pancreatic Surgery in Patients Receiving Direct Oral Anticoaulants (DOACs)

Introduction: The safety and optimal perioperative management of patients receiving direct oral anticoagulants (DOACs) during hepatobiliary and pancreatic (HBP) surgery is still controversial. Methods: Between 2012 and 2018, 115 anticoagulant-prescribed patients who underwent elective HBP surgery (65 benign and 50 malignant diseases, 69 laparoscopic and 46 open-fashioned operations) in our department were enrolled in this study. Patients undergoing emergency operations were excluded from the study. The patients were divided into two groups; patients receiving DOACs (DOAC group, n = 35) and patients undergoing warfarin therapy (WF group, n = 80). Background characteristics, surgical blood loss, and postoperative complications, including bleeding and thrombotic complications, were compared between the groups. Results: In the DOAC group, dabigatran, apixaban, rivaroxaban, and edoxaban were used in 10, 8, 10, and 7 patients, respectively, and only 11 patients (31.4%) received perioperative heparin bridging. There were no differences in patients´ background characteristics and mode of surgery (open or laparoscopic). The duration of operation (p = 0.148), surgical blood loss (p = 0.782), and the rate of intraoperative red blood cell transfusion (p = 1.000) were similar between the groups. Overall, any thromboembolic complications were not observed in the current cohort, and only 1 patient (2.9%) suffered from postoperative bleeding complication in the DOAC group. The mortality was zero, and the length of postoperative stay was also identical between the groups (p = 0.998). Conclusion: HBP surgery is safely performed in patients receiving DOAC therapy, without increase in bleeding or thromboembolic complications compared with warfarin therapy.

Descriptive and Survival Analysis after Pancreatic Surgery in Patients with Ductal Adenocarcinoma of the Pancreas

Purpose: Pancreatic ductal adenocarcinoma (PDAC) is considered one of the most aggressive solid tumors. The prognosis is poor and the 5 year survival is 5-7%. Surgical treatment is proven to prolong survival. The aim of the present study is to describe the clinical and epidemiologic characteristics of the patients operated for PDAC. Method: This is a retrospective study (2009-2019) of consecutive patients undergoing pancreatic surgery for PDCA between 2009 and 2019. Clinical, laboratory, radiological, histological, perioperative and survival parameters were evaluated. Results: A total of 27 patients were operated during the period of the study: 85,2 pancreaticoduodenectomy, 11,1%distal pancreatectomy and splenectomy and 3,7% total pancreatectomy, and 7.4% required portal vein resections.). Mean age was 62 years and 59.3% were male. Most patients were ASA III (59,3%). The recurrence rate was 44.4% distributed between local (25.9%), locoregional (22.2%), hepatic (22.2%) and pleural (11.1%) (Table 1). Median overall survival was 26.4 months, and the disease-free survival was 14.2 months. The 1-year and 5-year survival rates were 59.3% and 1.88% (Figure 1). Conclusions: The clinical, morbi-mortality and survival characteristics in our study group were similar to those described in the literature. This study confirms the high morbidity rates after pancreatic surgery and low rates of survival in resectable PDAC.Tabled 1Table 1: Demographic, clinical and perioperative characteristics of the patients with pancreatic resection with ductal adenocarcinoma of the pancreas.CharacteristicsAll patients (n = 27)Age (years)62 ± 4.2Gender Female11 (40.7%) Male16 (59.3%)Comorbidities HTA15 (55.6%) DM 211 (40.7%)Pneumopathy2 (7.4%)Cardiopathy5 (18.5%)Age adjusted Charlson Comorbidity Index5.6 ± 2.5BMI24 ±3.9ASA score II10 (37%) III16 (59.3%) IV1 (3.7%)Preoperative drainage Preoperative ERCP drain16 (59.3%) Preoperative PTC drain4 (14.8%)Procedure Whipple’s23 (85.2%) Distal Pancreatectomy + Splenectomy3 (11.1%) Total Pancreatectomy1 (3.7%)Portal Vein resection2 (7.4%)HistologyTumoral size (mm)25 (25-90)Resection margin R016 (59.3%) R111 (40.7%)Stage AJCC Ia3 (11.1%) Ib6 (22.2%) IIa3 (11.1%) IIb14 (51.8%) III1 (3.7%)Tumor grade G15 (18.5%) G216 (59.3%) G36 (22.2%)Perineural invasión22 (81.5%)Perivascular invasión5 (18.5%)Morbidity15 (44.4%)Clavien-Dindo≤ 26 (11.1%)Major complicactions (Clavien-Dindo> 39 (33.3%)Drainage amylase38 (4 – 30000)Lenght of hospital stay18 (13-47)Adyuvant treatment Chemotherapy11 (68.8%) Chemotherapy + Radiotherapy5 (31.2%)90 days readmission rate6 (22.2%)Overall survival36.1 ± 14.8Desease free survival35.5 ± 15.7 Open table in a new tab

Evaluating the impact of a nutrition-focused eras protocol in hepatobiliary and pancreatic surgery patients: a preliminary analysis

Presenter: Taylor Abraham MD | Bon Secours Mercy Health St. Elizabeth Youngstown Hospital Background: Nutritional status is an important independent predictor of clinical outcomes after surgery. Optimized surgical nutrition has been found to improve the clinical and health outcomes of surgical patients. A perioperative nutrition protocol was implemented to provide oral nutritional supplements to all eligible surgery patients in the perioperative period to optimize their nutritional status and improve their clinical outcomes. Methods: Between January 1, 2019 and November 1, 2020, patients scheduled to undergo major hepatobiliary or pancreatic surgery by a single surgeon at a single institution was seen by the registered oncology dietitian 1 week prior to surgery. During this visit, the patients were provided with 1 bottle of clear carbohydrate drink (Ensure Pre-Surgery), and 10 bottles of immunonutrition (Ensure Immunonutrition Surgery Shake). Patients also received an educational flyer outlining the benefits of nutritional supplements pre- and post-surgery as well as specific instructions and checklists to promote compliance. During the patient's hospital stay, the nutritional supplements were started per the surgical nutrition protocol and a 5-day supply of immunonutrition shakes (Ensure) or therapeutic nutrition powder for wound healing (Juven) were provided to take home and consume post-operatively. Outcomes of interest included length of hospital stay, 30-day readmissions and post-operative infectious complications. Outcomes of these patients were compared to those of historical controls - patients undergoing similar procedures between January and December of 2018, prior to the initiation of the nutrition protocol. Results: A total of 92 patients undergoing major hepatobiliary and pancreatic surgeries were included in the analysis of which 67 patients were given the perioperative nutrition protocol and 25 were historical controls. Overall, patients were mainly female (57%), on public insurance (57%) and had a mean age of 65. Comparative analysis showed improvements in favor of the perioperative nutrition protocol cohort in terms of reduced length of stay (8.54 vs. 7.89 days), 30-day readmissions (24% vs. 19%) and infectious complications (20% vs. 16.4%). Conclusion: The results of our analysis confirm the importance of perioperative nutrition protocols in optimizing the clinical outcomes of patients undergoing major hepatobiliary and pancreatic surgeries. The improvements observed can result in decreased financial burden for the patients and the institution. Future research is needed to validate the findings of our preliminary analysis.

A pilot study of mobile app utilization for enhanced post-operative nutritional recovery in pancreatic and hepatobiliary surgery patients

A pilot study of mobile app utilization for enhanced post-operative nutritional recovery in pancreatic and hepatobiliary surgery patients

Blood utilization and clinical outcomes in pancreatic surgery before and after implementation of patient blood management.

Over the past decade, patient blood management (PBM) programs have been developed to reduce allogeneic blood utilization. This is particularly important in pancreatic surgery, which has historically been associated with high transfusion requirements and morbid event rates. This study investigated blood utilization and clinical outcomes in pancreatic surgery before, during, and after the implementation of PBM. A total of 3482 pancreatic surgery patients were assessed in a 10-year retrospective cohort study (2009-2019) at a single academic center. Baseline patient characteristics, transfusion practices, postoperative morbidity (infectious, thrombotic, ischemic, respiratory, and renal complications), mortality, and length of stay were compared between patients in the pre-PBM (2009-2013), early-PBM (2014-2016), and mature-PBM (2017-2019) time periods. Multivariable analysis assessed the odds for composite morbidity/mortality. Comparing the mature-PBM to pre-PBM cohorts, transfused units per 100 discharged patients decreased by 53% for erythrocytes (155 to 73; P < .0001), 81% for plasma (79 to 15; P < .038), and 75% for platelets (10 to 2.5; P < .005). Clinical outcomes improved as well, with composite morbid event rates decreasing by more than 50%, from 236 in 1438 patients (16.4%) to 85 in 1145 patients (7.4%) (P < .0001). Mortality and length of stay remained unchanged. Compared to the pre-PBM time period, early-PBM was associated with a risk-adjusted decrease in composite morbidity/mortality (OR 0.73; 95% CI 0.57-0.93; P = .010), while mature-PBM demonstrated a further incremental decrease (OR 0.44; 95% CI 0.33-0.57; P < .0001). The implementation of PBM was associated with substantially decreased blood utilization in pancreatic surgery, without negatively impacting clinical outcomes.