Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway
Background Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Re...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2018-10, Vol.22 (10), p.1732-1742 |
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| container_title | Journal of gastrointestinal surgery |
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| creator | Agarwal, Vandana Thomas, Martin Jose Joshi, Riddhi Chaudhari, Vikram Bhandare, Manish Mitra, Abhishek deSouza, Ashwin Ambulkar, Reshma Shrikhande, Shailesh V. |
| description | Background
Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery.
Methods
Prospective study conducted from February 2014 to December 2016, following elective pancreatic cancer surgery. Team was educated prior to implementation of ERAS. Patients were followed up until 30 days postoperatively or discharge. Data was recorded regarding the compliance with the protocol, functional GI recovery, mobilisation, and postoperative morbidity and mortality.
Results
A total of 394 patients underwent surgery. Compliance with ER elements implemented was 84% (23–100%). Compliance > 80% with ER elements was observed in 278 patients (70.5%) and 80% compliance have significantly lower major complications (28.7 vs. 44%,
p
= 0.001), mortality (2.1 vs. 6.8%,
p
= 0.021), and postoperative stay (11 (5–78) days vs. 15 (4–61) days,
p
|
| doi_str_mv | 10.1007/s11605-018-3809-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2041054505</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2041054505</sourcerecordid><originalsourceid>FETCH-LOGICAL-c382t-ded9f180eda33e0027fc01c57fe408adabbf514a4aa0831f62ef177b9e121d5f3</originalsourceid><addsrcrecordid>eNp1kE1LAzEQhoMotlZ_gBcJeF6dySbNrjcpVQuFiih4MqTZiW2xuzXZKv33ptSPk6cM5HnfYR7GThEuEEBfRsQ-qAywyPICykzvsS4WOs9kX_T30wwlZkKp5w47inEBgDqxh6wjSq21VLLLXkbLVWg-qOKTdeuaJUU-r3leSn5vaxfItnPHB2mkwB8okmvnTR2veDsjnqLWtbzxfFjPtkiVEJfKwial29mn3RyzA2_fIp18vz32dDN8HNxl48ntaHA9zlxeiDarqCo9FkCVzXMCENo7QKe0JwmFrex06hVKK62FIkffF-RR62lJKLBSPu-x811vOuZ9TbE1i2Yd6rTSCJAISipQicId5UITYyBvVmG-tGFjEMzWqNkZNcmS2Ro1OmXOvpvX0yVVv4kfhQkQOyCmr_qVwt_q_1u_AJFagNw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2041054505</pqid></control><display><type>article</type><title>Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Agarwal, Vandana ; Thomas, Martin Jose ; Joshi, Riddhi ; Chaudhari, Vikram ; Bhandare, Manish ; Mitra, Abhishek ; deSouza, Ashwin ; Ambulkar, Reshma ; Shrikhande, Shailesh V.</creator><creatorcontrib>Agarwal, Vandana ; Thomas, Martin Jose ; Joshi, Riddhi ; Chaudhari, Vikram ; Bhandare, Manish ; Mitra, Abhishek ; deSouza, Ashwin ; Ambulkar, Reshma ; Shrikhande, Shailesh V.</creatorcontrib><description>Background
Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery.
Methods
Prospective study conducted from February 2014 to December 2016, following elective pancreatic cancer surgery. Team was educated prior to implementation of ERAS. Patients were followed up until 30 days postoperatively or discharge. Data was recorded regarding the compliance with the protocol, functional GI recovery, mobilisation, and postoperative morbidity and mortality.
Results
A total of 394 patients underwent surgery. Compliance with ER elements implemented was 84% (23–100%). Compliance > 80% with ER elements was observed in 278 patients (70.5%) and < 80% in 116 patients (29.5%). Patients with > 80% compliance have significantly lower major complications (28.7 vs. 44%,
p
= 0.001), mortality (2.1 vs. 6.8%,
p
= 0.021), and postoperative stay (11 (5–78) days vs. 15 (4–61) days,
p
< 0.001).
Conclusion
ER programme is feasible and safe in resource and infrastructure limited lower middle-income country. Improved compliance was associated with reduced major complications, mortality, and shorter stay in patients undergoing pancreatic cancer surgery in high-volume centre.
Trial Registration
CTRI/2015/01/005393 (
www.ctri.nic.in
)</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-018-3809-7</identifier><identifier>PMID: 29777454</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adenocarcinoma - surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cancer surgery ; Compliance ; Elective Surgical Procedures ; Female ; Gastroenterology ; Gastrointestinal surgery ; Humans ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity ; Mortality ; Original Article ; Pancreatic cancer ; Pancreatic Neoplasms - surgery ; Patient Compliance ; Perioperative Care - methods ; Postoperative Complications ; Postoperative Period ; Prospective Studies ; Recovery (Medical) ; Recovery of Function ; Surgery ; Young Adult</subject><ispartof>Journal of gastrointestinal surgery, 2018-10, Vol.22 (10), p.1732-1742</ispartof><rights>The Society for Surgery of the Alimentary Tract 2018</rights><rights>Journal of Gastrointestinal Surgery is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c382t-ded9f180eda33e0027fc01c57fe408adabbf514a4aa0831f62ef177b9e121d5f3</citedby><cites>FETCH-LOGICAL-c382t-ded9f180eda33e0027fc01c57fe408adabbf514a4aa0831f62ef177b9e121d5f3</cites><orcidid>0000-0002-3593-0414</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-018-3809-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-018-3809-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29777454$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Agarwal, Vandana</creatorcontrib><creatorcontrib>Thomas, Martin Jose</creatorcontrib><creatorcontrib>Joshi, Riddhi</creatorcontrib><creatorcontrib>Chaudhari, Vikram</creatorcontrib><creatorcontrib>Bhandare, Manish</creatorcontrib><creatorcontrib>Mitra, Abhishek</creatorcontrib><creatorcontrib>deSouza, Ashwin</creatorcontrib><creatorcontrib>Ambulkar, Reshma</creatorcontrib><creatorcontrib>Shrikhande, Shailesh V.</creatorcontrib><title>Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Background
Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery.
Methods
Prospective study conducted from February 2014 to December 2016, following elective pancreatic cancer surgery. Team was educated prior to implementation of ERAS. Patients were followed up until 30 days postoperatively or discharge. Data was recorded regarding the compliance with the protocol, functional GI recovery, mobilisation, and postoperative morbidity and mortality.
Results
A total of 394 patients underwent surgery. Compliance with ER elements implemented was 84% (23–100%). Compliance > 80% with ER elements was observed in 278 patients (70.5%) and < 80% in 116 patients (29.5%). Patients with > 80% compliance have significantly lower major complications (28.7 vs. 44%,
p
= 0.001), mortality (2.1 vs. 6.8%,
p
= 0.021), and postoperative stay (11 (5–78) days vs. 15 (4–61) days,
p
< 0.001).
Conclusion
ER programme is feasible and safe in resource and infrastructure limited lower middle-income country. Improved compliance was associated with reduced major complications, mortality, and shorter stay in patients undergoing pancreatic cancer surgery in high-volume centre.
Trial Registration
CTRI/2015/01/005393 (
www.ctri.nic.in
)</description><subject>Adenocarcinoma - surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer surgery</subject><subject>Compliance</subject><subject>Elective Surgical Procedures</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Patient Compliance</subject><subject>Perioperative Care - methods</subject><subject>Postoperative Complications</subject><subject>Postoperative Period</subject><subject>Prospective Studies</subject><subject>Recovery (Medical)</subject><subject>Recovery of Function</subject><subject>Surgery</subject><subject>Young Adult</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1LAzEQhoMotlZ_gBcJeF6dySbNrjcpVQuFiih4MqTZiW2xuzXZKv33ptSPk6cM5HnfYR7GThEuEEBfRsQ-qAywyPICykzvsS4WOs9kX_T30wwlZkKp5w47inEBgDqxh6wjSq21VLLLXkbLVWg-qOKTdeuaJUU-r3leSn5vaxfItnPHB2mkwB8okmvnTR2veDsjnqLWtbzxfFjPtkiVEJfKwial29mn3RyzA2_fIp18vz32dDN8HNxl48ntaHA9zlxeiDarqCo9FkCVzXMCENo7QKe0JwmFrex06hVKK62FIkffF-RR62lJKLBSPu-x811vOuZ9TbE1i2Yd6rTSCJAISipQicId5UITYyBvVmG-tGFjEMzWqNkZNcmS2Ro1OmXOvpvX0yVVv4kfhQkQOyCmr_qVwt_q_1u_AJFagNw</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>Agarwal, Vandana</creator><creator>Thomas, Martin Jose</creator><creator>Joshi, Riddhi</creator><creator>Chaudhari, Vikram</creator><creator>Bhandare, Manish</creator><creator>Mitra, Abhishek</creator><creator>deSouza, Ashwin</creator><creator>Ambulkar, Reshma</creator><creator>Shrikhande, Shailesh V.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><orcidid>https://orcid.org/0000-0002-3593-0414</orcidid></search><sort><creationdate>20181001</creationdate><title>Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway</title><author>Agarwal, Vandana ; Thomas, Martin Jose ; Joshi, Riddhi ; Chaudhari, Vikram ; Bhandare, Manish ; Mitra, Abhishek ; deSouza, Ashwin ; Ambulkar, Reshma ; Shrikhande, Shailesh V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382t-ded9f180eda33e0027fc01c57fe408adabbf514a4aa0831f62ef177b9e121d5f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adenocarcinoma - surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer surgery</topic><topic>Compliance</topic><topic>Elective Surgical Procedures</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Patient Compliance</topic><topic>Perioperative Care - methods</topic><topic>Postoperative Complications</topic><topic>Postoperative Period</topic><topic>Prospective Studies</topic><topic>Recovery (Medical)</topic><topic>Recovery of Function</topic><topic>Surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Agarwal, Vandana</creatorcontrib><creatorcontrib>Thomas, Martin Jose</creatorcontrib><creatorcontrib>Joshi, Riddhi</creatorcontrib><creatorcontrib>Chaudhari, Vikram</creatorcontrib><creatorcontrib>Bhandare, Manish</creatorcontrib><creatorcontrib>Mitra, Abhishek</creatorcontrib><creatorcontrib>deSouza, Ashwin</creatorcontrib><creatorcontrib>Ambulkar, Reshma</creatorcontrib><creatorcontrib>Shrikhande, Shailesh V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Agarwal, Vandana</au><au>Thomas, Martin Jose</au><au>Joshi, Riddhi</au><au>Chaudhari, Vikram</au><au>Bhandare, Manish</au><au>Mitra, Abhishek</au><au>deSouza, Ashwin</au><au>Ambulkar, Reshma</au><au>Shrikhande, Shailesh V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>22</volume><issue>10</issue><spage>1732</spage><epage>1742</epage><pages>1732-1742</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Background
Enhanced recovery (ER) pathway reduces morbidity and accelerates recovery. It is associated with reduced postoperative stay, morbidity, and costs. Feasibility and safety of ER programme has not been studied in developing countries. The objectives were to assess compliance with Enhanced Recovery After Surgery (ERAS) elements and to assess outcomes in pancreatic surgery.
Methods
Prospective study conducted from February 2014 to December 2016, following elective pancreatic cancer surgery. Team was educated prior to implementation of ERAS. Patients were followed up until 30 days postoperatively or discharge. Data was recorded regarding the compliance with the protocol, functional GI recovery, mobilisation, and postoperative morbidity and mortality.
Results
A total of 394 patients underwent surgery. Compliance with ER elements implemented was 84% (23–100%). Compliance > 80% with ER elements was observed in 278 patients (70.5%) and < 80% in 116 patients (29.5%). Patients with > 80% compliance have significantly lower major complications (28.7 vs. 44%,
p
= 0.001), mortality (2.1 vs. 6.8%,
p
= 0.021), and postoperative stay (11 (5–78) days vs. 15 (4–61) days,
p
< 0.001).
Conclusion
ER programme is feasible and safe in resource and infrastructure limited lower middle-income country. Improved compliance was associated with reduced major complications, mortality, and shorter stay in patients undergoing pancreatic cancer surgery in high-volume centre.
Trial Registration
CTRI/2015/01/005393 (
www.ctri.nic.in
)</abstract><cop>New York</cop><pub>Springer US</pub><pmid>29777454</pmid><doi>10.1007/s11605-018-3809-7</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-3593-0414</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 2018-10, Vol.22 (10), p.1732-1742 |
| issn | 1091-255X 1873-4626 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adenocarcinoma - surgery Adolescent Adult Aged Aged, 80 and over Cancer surgery Compliance Elective Surgical Procedures Female Gastroenterology Gastrointestinal surgery Humans Length of Stay Male Medicine Medicine & Public Health Middle Aged Morbidity Mortality Original Article Pancreatic cancer Pancreatic Neoplasms - surgery Patient Compliance Perioperative Care - methods Postoperative Complications Postoperative Period Prospective Studies Recovery (Medical) Recovery of Function Surgery Young Adult |
| title | Improved Outcomes in 394 Pancreatic Cancer Resections: the Impact of Enhanced Recovery Pathway |
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