Systematic Review and Meta-analysis of Enhanced Recovery After Pancreatic Surgery with Particular Emphasis on Pancreatic
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Systematic Review and Meta-analysis of Enhanced Recovery After Pancreatic Surgery with Particular Emphasis on Pancreaticoduodenectomies M. M. E. Coolsen • R. M. van Dam • A. A. van der Wilt • K. Slim • K. Lassen C. H. C. Dejong
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Ó Socie´te´ Internationale de Chirurgie 2013
Abstract Background In the past decade, Enhanced Recovery after Surgery (ERAS) protocols have been implemented in several fields of surgery. With these protocols, a faster recovery and shorter hospital stay can be accomplished without an increase in morbidity or mortality. The purpose of this study was to review systematically the evidence for implementation of an ERAS protocol in pancreatic
Electronic supplementary material The online version of this article (doi:10.1007/s00268-013-2044-3) contains supplementary material, which is available to authorized users. M. M. E. Coolsen (&) R. M. van Dam A. A. van der Wilt C. H. C. Dejong Department of Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands e-mail: [email protected] K. Slim Department of General and Digestive Surgery, CHU Estaing, Clermont-Ferrand, France K. Lassen Department of Gastrointestinal Surgery, University Hospital Northern Norway, Tromsø, Norway K. Lassen Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway K. Lassen Clinical and Surgical Sciences (Surgery), Royal Infirmary, Edinburgh, UK C. H. C. Dejong NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
resections, with particular emphasis on pancreaticoduodenectomies (PDs). Methods A systematic search was performed in Medline, Embase, Pubmed, CINAHL, and the Cochrane library for papers describing an ERAS program in adult patients undergoing elective pancreatic surgery published between January 1966 and December 2012. The primary outcome measure was postoperative length of stay. Secondary outcome measures were time to recovery of normal function, overall postoperative complication rates, readmissions, and mortality. Subsequently, a meta-analysis of outcome measures focusing on PD was conducted. This systematic review and meta-analysis was performed according to the PRISMA statement. Results The literature search produced 248 potentially relevant papers. Of these, eight papers met the predefined inclusion criteria: five case-control studies, two retrospective studies, and one prospective study, describing a total of 1,558 patients. Only three of the studies reported data on discharge criteria and assessed time to recovery and return to normal function. Implementation of an ERAS protocol led in four of five comparative studies to a significant decrease in length of stay (reduction of 2–6 days in different studies). Meta-analysis of four studies focusing on PDs showed that there was a significant difference in complication rates in favor of the ERAS group (absolute risk difference 8.2 %, 95 % confidence interval (CI) 2.0–14.4, p = 0.008). Introduction of an ERAS protocol did n
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