Background/Purpose

There is no data regarding the impact of enhanced recovery pathways (ERP) on composite length of stay (CLOS) after procedures with increased risk of morbidity and mortality, such as pancreaticoduodenectomy.

Methods

Patients undergoing open pancreaticoduodenectomy before and after implementation of ERP were prospectively followed for 90 days after surgery and complications were severity graded using the Modified Accordion Grading System. A retrospective analysis of patient outcomes were compared before and after instituting ERP. 1:1 propensity score matching was used to compare ERP patient outcomes to those of matched pre-ERP patients. CLOS is defined as postoperative length of hospital stay (PLOS) plus readmission length of hospital stay within 90 days after surgery.

Results

494 patients underwent open pancreaticoduodenectomy – 359 pre-ERP and 135 ERP. In a 1:1 propensity-score-matched analysis of 110 matched pairs, ERP patients had significantly decreased superficial surgical site infections (5.5% vs 15.5% p = 0.015) and significantly increased rates of urinary retention (29.1% vs 7.3% p < 0.0001) compared to matched pre-ERP patients. However, overall complication rate and 90-day readmission rate were not significantly different between matched groups. Propensity score-matched ERP patients had significantly decreased PLOS (7 days vs 8 days p = 0.046) compared to matched pre-ERP patients, but CLOS was not significantly different (9 days vs 9.5 days p = 0.615).

Conclusion

ERP may reduce PLOS but might not impact the total postoperative time spent in the hospital (i.e. CLOS) within 90 days after pancreaticoduodenectomy.

中文翻译：

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开放式胰十二指肠切除术后增强康复路径可缩短术后住院时间，但不会缩短复合住院时间

背景/目的

没有关于增强恢复途径 (ERP) 对发病率和死亡率风险增加的手术（例如胰十二指肠切除术）后复合住院时间 (CLOS) 的影响的数据。

方法

在实施 ERP 之前和之后接受开放式胰十二指肠切除术的患者在手术后进行了 90 天的前瞻性随访，并使用改良的手风琴分级系统对并发症的严重程度进行了分级。对实施 ERP 之前和之后的患者结果进行回顾性分析。1:1 倾向评分匹配用于比较 ERP 患者的结果与匹配的 ERP 前患者的结果。CLOS 定义为术后住院时间 (PLOS) 加上术后 90 天内再次入院的住院时间。

结果

494 名患者接受了开放式胰十二指肠切除术——359 名 ERP 前患者和 135 名 ERP 患者。在对 110 对配对进行的 1:1 倾向得分匹配分析中，ERP 患者的浅表手术部位感染显着减少（5.5% 对 15.5% p = 0.015），尿潴留率显着增加（29.1% 对 7.3% p < 0.0001) 与匹配的 ERP 前患者相比。然而，总体并发症发生率和 90 天再入院率在匹配组之间没有显着差异。与匹配的 ERP 前患者相比，倾向评分匹配的 ERP 患者的 PLOS 显着降低（7 天对 8 天 p = 0.046），但 CLOS 没有显着差异（9 天对 9.5 天 p = 0.615）。

结论

ERP 可能会减少 PLOS，但可能不会影响胰十二指肠切除术后 90 天内住院的总术后时间（即 CLOS）。