Effect of Enhanced Recovery After Surgery program on pancreaticoduodenectomy: a randomized controlled trial
Background This study aims to investigate the noninferiority of Enhanced Recovery After Surgery (ERAS) for pancreaticoduodenectomy (PD). Methods In this single‐center trial, we randomly assigned 276 adult patients who underwent open PD into ERAS and conventional groups with 138 patients in each, fro...
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| Veröffentlicht in: | Journal of hepato-biliary-pancreatic sciences 2019-08, Vol.26 (8), p.360-369 |
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| container_title | Journal of hepato-biliary-pancreatic sciences |
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| creator | Hwang, Dae Wook Kim, Hwa Jung Lee, Jae Hoon Song, Ki Byung Kim, Myeong‐Hwan Lee, Sung Koo Choi, Kyu Taek Jun, In‐Gu Bang, Ji‐Yeon Kim, Song Cheol |
| description | Background
This study aims to investigate the noninferiority of Enhanced Recovery After Surgery (ERAS) for pancreaticoduodenectomy (PD).
Methods
In this single‐center trial, we randomly assigned 276 adult patients who underwent open PD into ERAS and conventional groups with 138 patients in each, from 2015 through 2017. The primary endpoint was the incidence of overall morbidity until postoperative 3 months. The secondary endpoints were in‐hospital or 30‐day mortality, postoperative length of stay (LOS), nutritional status and overall hospital costs.
Results
Overall morbidity was reported in 64 patients (52.0%, ERAS group) and in 68 patients (54.8%, conventional group) (risk difference [RD] −2.81 percentage points (pp); 90% two‐sided confidence interval −13.24 to 7.63). Mortality did not occur in any patients. The two groups did not differ significantly in median postoperative LOS (both 11 days; RD −8.46 pp), body mass index (22.4 ± 2.75 vs. 22.4 ± 2.65 kg/m2; RD −3.48 pp), Patient‐Generated Subjective Global Assessment score over 4 (45 [40.5%] vs. 50 [43.1%] patients; RD −2.56 pp), and median overall hospital cost (15.61 vs. 16.04, ×106 KRW; RD −6.08 pp).
Conclusions
Even in PD, modified ERAS protocol was not inferior to conventional protocol, while reducing treatment burden.
Highlight
This randomized clinical trial by Hwang and colleagues revealed that the Enhanced Recovery After Surgery (ERAS) protocol was not inferior to the conventional perioperative management protocol for pancreaticoduodenectomy regarding morbidity, mortality, length of stay and hospital cost. The ERAS protocol not only reduces treatment burden, but also facilitates treatment administration. |
| doi_str_mv | 10.1002/jhbp.641 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2233865471</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2233865471</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4391-d93bf0ffbb787c22fcb326ad1422151fc2d6527e67f74d8a74563c906a1a83f23</originalsourceid><addsrcrecordid>eNp1kdtKw0AQhhdRbKmCTyAL3niTmj1kd-NdLdUqguLhOmz20KYm2bpJlPj0blErCM7NzMDHxzA_AEcoHqM4xmerZb4eM4p2wBAJJiKWCry7nTkdgMOmWcWhCCIpiffBgCCUYCbYELzMrDWqhc7CWb2UtTIaPhjl3ozv4cS2xsPHzi8229q7hZcVdDVcB9Ab2RbK6c5pUweFq_pzKKGXtXZV8RE8ytWtd2UZxtYXsjwAe1aWjTn87iPwfDl7ms6j27ur6-nkNlKUpCjSKcltbG2ec8EVxlblBDOpEcUYJcgqrFmCuWHccqqF5DRhRKUxk0gKYjEZgdMvb7j4tTNNm1VFo0xZytq4rskwJkSwhHIU0JM_6Mp1vg7XBYoJSjgh9FeovGsab2y29kUlfZ-hONtkkG0yyEIGAT3-FnZ5ZfQW_Pl4AKIv4L0oTf-vKLuZX9xvhJ8jQ5Cf</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2268437334</pqid></control><display><type>article</type><title>Effect of Enhanced Recovery After Surgery program on pancreaticoduodenectomy: a randomized controlled trial</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Hwang, Dae Wook ; Kim, Hwa Jung ; Lee, Jae Hoon ; Song, Ki Byung ; Kim, Myeong‐Hwan ; Lee, Sung Koo ; Choi, Kyu Taek ; Jun, In‐Gu ; Bang, Ji‐Yeon ; Kim, Song Cheol</creator><creatorcontrib>Hwang, Dae Wook ; Kim, Hwa Jung ; Lee, Jae Hoon ; Song, Ki Byung ; Kim, Myeong‐Hwan ; Lee, Sung Koo ; Choi, Kyu Taek ; Jun, In‐Gu ; Bang, Ji‐Yeon ; Kim, Song Cheol</creatorcontrib><description>Background
This study aims to investigate the noninferiority of Enhanced Recovery After Surgery (ERAS) for pancreaticoduodenectomy (PD).
Methods
In this single‐center trial, we randomly assigned 276 adult patients who underwent open PD into ERAS and conventional groups with 138 patients in each, from 2015 through 2017. The primary endpoint was the incidence of overall morbidity until postoperative 3 months. The secondary endpoints were in‐hospital or 30‐day mortality, postoperative length of stay (LOS), nutritional status and overall hospital costs.
Results
Overall morbidity was reported in 64 patients (52.0%, ERAS group) and in 68 patients (54.8%, conventional group) (risk difference [RD] −2.81 percentage points (pp); 90% two‐sided confidence interval −13.24 to 7.63). Mortality did not occur in any patients. The two groups did not differ significantly in median postoperative LOS (both 11 days; RD −8.46 pp), body mass index (22.4 ± 2.75 vs. 22.4 ± 2.65 kg/m2; RD −3.48 pp), Patient‐Generated Subjective Global Assessment score over 4 (45 [40.5%] vs. 50 [43.1%] patients; RD −2.56 pp), and median overall hospital cost (15.61 vs. 16.04, ×106 KRW; RD −6.08 pp).
Conclusions
Even in PD, modified ERAS protocol was not inferior to conventional protocol, while reducing treatment burden.
Highlight
This randomized clinical trial by Hwang and colleagues revealed that the Enhanced Recovery After Surgery (ERAS) protocol was not inferior to the conventional perioperative management protocol for pancreaticoduodenectomy regarding morbidity, mortality, length of stay and hospital cost. The ERAS protocol not only reduces treatment burden, but also facilitates treatment administration.</description><identifier>ISSN: 1868-6974</identifier><identifier>EISSN: 1868-6982</identifier><identifier>DOI: 10.1002/jhbp.641</identifier><identifier>PMID: 31152686</identifier><language>eng</language><publisher>Japan: Wiley Subscription Services, Inc</publisher><subject>Academic Medical Centers ; Adult ; Aged ; Enhanced Recovery After Surgery ; Fast track ; Follow-Up Studies ; Hospital costs ; Humans ; Middle Aged ; Mortality ; Multivariate Analysis ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - methods ; Perioperative management ; Postoperative Care - methods ; Postoperative outcomes ; Proportional Hazards Models ; Prospective Studies ; Recovery of Function - physiology ; Republic of Korea ; Risk Assessment ; Statistics, Nonparametric ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of hepato-biliary-pancreatic sciences, 2019-08, Vol.26 (8), p.360-369</ispartof><rights>2019 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery</rights><rights>2019 Japanese Society of Hepato-Biliary-Pancreatic Surgery.</rights><rights>Copyright © 2019 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4391-d93bf0ffbb787c22fcb326ad1422151fc2d6527e67f74d8a74563c906a1a83f23</citedby><cites>FETCH-LOGICAL-c4391-d93bf0ffbb787c22fcb326ad1422151fc2d6527e67f74d8a74563c906a1a83f23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjhbp.641$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjhbp.641$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31152686$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hwang, Dae Wook</creatorcontrib><creatorcontrib>Kim, Hwa Jung</creatorcontrib><creatorcontrib>Lee, Jae Hoon</creatorcontrib><creatorcontrib>Song, Ki Byung</creatorcontrib><creatorcontrib>Kim, Myeong‐Hwan</creatorcontrib><creatorcontrib>Lee, Sung Koo</creatorcontrib><creatorcontrib>Choi, Kyu Taek</creatorcontrib><creatorcontrib>Jun, In‐Gu</creatorcontrib><creatorcontrib>Bang, Ji‐Yeon</creatorcontrib><creatorcontrib>Kim, Song Cheol</creatorcontrib><title>Effect of Enhanced Recovery After Surgery program on pancreaticoduodenectomy: a randomized controlled trial</title><title>Journal of hepato-biliary-pancreatic sciences</title><addtitle>J Hepatobiliary Pancreat Sci</addtitle><description>Background
This study aims to investigate the noninferiority of Enhanced Recovery After Surgery (ERAS) for pancreaticoduodenectomy (PD).
Methods
In this single‐center trial, we randomly assigned 276 adult patients who underwent open PD into ERAS and conventional groups with 138 patients in each, from 2015 through 2017. The primary endpoint was the incidence of overall morbidity until postoperative 3 months. The secondary endpoints were in‐hospital or 30‐day mortality, postoperative length of stay (LOS), nutritional status and overall hospital costs.
Results
Overall morbidity was reported in 64 patients (52.0%, ERAS group) and in 68 patients (54.8%, conventional group) (risk difference [RD] −2.81 percentage points (pp); 90% two‐sided confidence interval −13.24 to 7.63). Mortality did not occur in any patients. The two groups did not differ significantly in median postoperative LOS (both 11 days; RD −8.46 pp), body mass index (22.4 ± 2.75 vs. 22.4 ± 2.65 kg/m2; RD −3.48 pp), Patient‐Generated Subjective Global Assessment score over 4 (45 [40.5%] vs. 50 [43.1%] patients; RD −2.56 pp), and median overall hospital cost (15.61 vs. 16.04, ×106 KRW; RD −6.08 pp).
Conclusions
Even in PD, modified ERAS protocol was not inferior to conventional protocol, while reducing treatment burden.
Highlight
This randomized clinical trial by Hwang and colleagues revealed that the Enhanced Recovery After Surgery (ERAS) protocol was not inferior to the conventional perioperative management protocol for pancreaticoduodenectomy regarding morbidity, mortality, length of stay and hospital cost. The ERAS protocol not only reduces treatment burden, but also facilitates treatment administration.</description><subject>Academic Medical Centers</subject><subject>Adult</subject><subject>Aged</subject><subject>Enhanced Recovery After Surgery</subject><subject>Fast track</subject><subject>Follow-Up Studies</subject><subject>Hospital costs</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Perioperative management</subject><subject>Postoperative Care - methods</subject><subject>Postoperative outcomes</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Recovery of Function - physiology</subject><subject>Republic of Korea</subject><subject>Risk Assessment</subject><subject>Statistics, Nonparametric</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1868-6974</issn><issn>1868-6982</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kdtKw0AQhhdRbKmCTyAL3niTmj1kd-NdLdUqguLhOmz20KYm2bpJlPj0blErCM7NzMDHxzA_AEcoHqM4xmerZb4eM4p2wBAJJiKWCry7nTkdgMOmWcWhCCIpiffBgCCUYCbYELzMrDWqhc7CWb2UtTIaPhjl3ozv4cS2xsPHzi8229q7hZcVdDVcB9Ab2RbK6c5pUweFq_pzKKGXtXZV8RE8ytWtd2UZxtYXsjwAe1aWjTn87iPwfDl7ms6j27ur6-nkNlKUpCjSKcltbG2ec8EVxlblBDOpEcUYJcgqrFmCuWHccqqF5DRhRKUxk0gKYjEZgdMvb7j4tTNNm1VFo0xZytq4rskwJkSwhHIU0JM_6Mp1vg7XBYoJSjgh9FeovGsab2y29kUlfZ-hONtkkG0yyEIGAT3-FnZ5ZfQW_Pl4AKIv4L0oTf-vKLuZX9xvhJ8jQ5Cf</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Hwang, Dae Wook</creator><creator>Kim, Hwa Jung</creator><creator>Lee, Jae Hoon</creator><creator>Song, Ki Byung</creator><creator>Kim, Myeong‐Hwan</creator><creator>Lee, Sung Koo</creator><creator>Choi, Kyu Taek</creator><creator>Jun, In‐Gu</creator><creator>Bang, Ji‐Yeon</creator><creator>Kim, Song Cheol</creator><general>Wiley Subscription Services, Inc</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>K9.</scope><scope>7X8</scope></search><sort><creationdate>201908</creationdate><title>Effect of Enhanced Recovery After Surgery program on pancreaticoduodenectomy: a randomized controlled trial</title><author>Hwang, Dae Wook ; Kim, Hwa Jung ; Lee, Jae Hoon ; Song, Ki Byung ; Kim, Myeong‐Hwan ; Lee, Sung Koo ; Choi, Kyu Taek ; Jun, In‐Gu ; Bang, Ji‐Yeon ; Kim, Song Cheol</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4391-d93bf0ffbb787c22fcb326ad1422151fc2d6527e67f74d8a74563c906a1a83f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Academic Medical Centers</topic><topic>Adult</topic><topic>Aged</topic><topic>Enhanced Recovery After Surgery</topic><topic>Fast track</topic><topic>Follow-Up Studies</topic><topic>Hospital costs</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Perioperative management</topic><topic>Postoperative Care - methods</topic><topic>Postoperative outcomes</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Recovery of Function - physiology</topic><topic>Republic of Korea</topic><topic>Risk Assessment</topic><topic>Statistics, Nonparametric</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hwang, Dae Wook</creatorcontrib><creatorcontrib>Kim, Hwa Jung</creatorcontrib><creatorcontrib>Lee, Jae Hoon</creatorcontrib><creatorcontrib>Song, Ki Byung</creatorcontrib><creatorcontrib>Kim, Myeong‐Hwan</creatorcontrib><creatorcontrib>Lee, Sung Koo</creatorcontrib><creatorcontrib>Choi, Kyu Taek</creatorcontrib><creatorcontrib>Jun, In‐Gu</creatorcontrib><creatorcontrib>Bang, Ji‐Yeon</creatorcontrib><creatorcontrib>Kim, Song Cheol</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 Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hepato-biliary-pancreatic sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hwang, Dae Wook</au><au>Kim, Hwa Jung</au><au>Lee, Jae Hoon</au><au>Song, Ki Byung</au><au>Kim, Myeong‐Hwan</au><au>Lee, Sung Koo</au><au>Choi, Kyu Taek</au><au>Jun, In‐Gu</au><au>Bang, Ji‐Yeon</au><au>Kim, Song Cheol</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Enhanced Recovery After Surgery program on pancreaticoduodenectomy: a randomized controlled trial</atitle><jtitle>Journal of hepato-biliary-pancreatic sciences</jtitle><addtitle>J Hepatobiliary Pancreat Sci</addtitle><date>2019-08</date><risdate>2019</risdate><volume>26</volume><issue>8</issue><spage>360</spage><epage>369</epage><pages>360-369</pages><issn>1868-6974</issn><eissn>1868-6982</eissn><abstract>Background
This study aims to investigate the noninferiority of Enhanced Recovery After Surgery (ERAS) for pancreaticoduodenectomy (PD).
Methods
In this single‐center trial, we randomly assigned 276 adult patients who underwent open PD into ERAS and conventional groups with 138 patients in each, from 2015 through 2017. The primary endpoint was the incidence of overall morbidity until postoperative 3 months. The secondary endpoints were in‐hospital or 30‐day mortality, postoperative length of stay (LOS), nutritional status and overall hospital costs.
Results
Overall morbidity was reported in 64 patients (52.0%, ERAS group) and in 68 patients (54.8%, conventional group) (risk difference [RD] −2.81 percentage points (pp); 90% two‐sided confidence interval −13.24 to 7.63). Mortality did not occur in any patients. The two groups did not differ significantly in median postoperative LOS (both 11 days; RD −8.46 pp), body mass index (22.4 ± 2.75 vs. 22.4 ± 2.65 kg/m2; RD −3.48 pp), Patient‐Generated Subjective Global Assessment score over 4 (45 [40.5%] vs. 50 [43.1%] patients; RD −2.56 pp), and median overall hospital cost (15.61 vs. 16.04, ×106 KRW; RD −6.08 pp).
Conclusions
Even in PD, modified ERAS protocol was not inferior to conventional protocol, while reducing treatment burden.
Highlight
This randomized clinical trial by Hwang and colleagues revealed that the Enhanced Recovery After Surgery (ERAS) protocol was not inferior to the conventional perioperative management protocol for pancreaticoduodenectomy regarding morbidity, mortality, length of stay and hospital cost. The ERAS protocol not only reduces treatment burden, but also facilitates treatment administration.</abstract><cop>Japan</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31152686</pmid><doi>10.1002/jhbp.641</doi><tpages>10</tpages></addata></record> |
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| identifier | ISSN: 1868-6974 |
| ispartof | Journal of hepato-biliary-pancreatic sciences, 2019-08, Vol.26 (8), p.360-369 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Academic Medical Centers Adult Aged Enhanced Recovery After Surgery Fast track Follow-Up Studies Hospital costs Humans Middle Aged Mortality Multivariate Analysis Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy Pancreaticoduodenectomy - adverse effects Pancreaticoduodenectomy - methods Perioperative management Postoperative Care - methods Postoperative outcomes Proportional Hazards Models Prospective Studies Recovery of Function - physiology Republic of Korea Risk Assessment Statistics, Nonparametric Time Factors Treatment Outcome |
| title | Effect of Enhanced Recovery After Surgery program on pancreaticoduodenectomy: a randomized controlled trial |
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