Application of multi-subjects and multi-modes intervention in the enhanced recovery afterpancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FAN Wen ,  TIAN Bole

Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

TIAN Bole, Email: hxtbl0338@126.com

Keywords：

enhanced recovery after surgery; pancreatoduodenectomy; application significance

DOI：

10.7507/1007-9424.201710048

Video：

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Objective The objective of this study is to evaluate the effect of enhanced recovery after surgery (ERAS) in the perioperative period of pancreatoduodenectomy. Methods This article conducted the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from January 2016 to June 2017, and then compared the differences between the patients subjected to ERAS (ERAS group) and thosesubjected to regular measures (control group) with respect to time of setting in sickbed, time of mobilizing out ofsickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses, postoperative complications, and postoperative pain scores. Results ① Postoperative indexes: by comparison of the ERAS group and the control group, it was found that the ERAS group had shorter (or lower) time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses (P<0.05). ② Postoperative complications: of all postoperative complications, including pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences (P>0.05) between the 2 groups.③ Reoperation and readmission: there was no significant difference on the incidences of reoperation and readmission between the 2 groups (P>0.05). ④ Postoperative pain scores: except 22 : 00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1–6 days after operation (8 : 00, 16 : 00, and 22 : 00), with statistically differences (P<0.05). Conclusion Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.

Citation： FAN Wen, TIAN Bole. Application of multi-subjects and multi-modes intervention in the enhanced recovery afterpancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(6): 695-701. doi: 10.7507/1007-9424.201710048 Copy

1.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
2.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
3.	Bu J, Li N, Huang X, et al. Feasibility of fast-track surgery in elderly patients with gastric cancer. J Gastrointest Surg, 2015, 19(8): 1391-1398.
4.	Dorcaratto D, Grande L, Pera M. Enhanced recovery in gastrointestinal surgery: upper gastrointestinal surgery. Dig Surg, 2013, 30(1): 70-78.
5.	Karran A, Wheat J, Chan D, et al. Propensity score analysis of an enhanced recovery programme in upper gastrointestinal cancer surgery. World J Surg, 2016, 40(7): 1645-1654.
6.	Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford), 2014, 16(8): 699-706.
7.	Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
8.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
9.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
10.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
11.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
12.	Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
13.	中国研究型医院学会肝胆胰外科专业委员会; 董家鸿, 梁延波. 中国肝胆胰外科术后加速康复外科专家共识. 中华消化外科杂志, 2015, 15(1): 1-6.
14.	中国加速康复外科专家组; 赵玉沛. 中国加速康复外科围手术期管理专家共识. 中华外科杂志, 2016, 54(6): 413-418.
15.	Dai J, Jiang Y, Fu D. Reducing postoperative complications and improving clinical outcome: enhanced recovery after surgery in pancreaticoduodenectomy －a retrospective cohort study. Int J Surg, 2017, 39: 176-181.
16.	Xiong J, Szatmary P, Huang W, et al. Enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2016, 95(18): e3497.
17.	Zausig YA, Weigand MA, Graf BM. Perioperative fluid management: an analysis of the present situation. Anaesthesist, 2006, 55(4): 371-390.
18.	Goonetilleke KS, Siriwardena AK. Systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy. JOP, 2006, 7(1): 5-13.
19.	Pappas S, Krzywda E, McDowell N. Nutrition and pancreaticoduodenectomy. Nutr Clin Pract, 2010, 25(3): 234-243.
20.	Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev, 2007, (3): CD004929.
21.	Bauer VP. The evidence against prophylactic nasogastric intubation and oral restriction. Clin Colon Rectal Surg, 2013, 26(3): 182-185.
22.	Coolsen MM, van Dam RM, Chigharoe A, et al. Improving outcome after pancreaticoduodenectomy: experiences with implementing an enhanced recovery after surgery (ERAS) program. Dig Surg, 2014, 31(3): 177-184.
23.	Braga M, Pecorelli N, Ariotti R, et al. Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J Surg, 2014, 38(11): 2960-2966.
24.	di Sebastiano P, Festa L, De Bonis A, et al. A modified fast-track program for pancreatic surgery: a prospective single-center experience. Langenbecks Arch Surg, 2011, 396(3): 345-351.
25.	陈月琴, 任迎彬, 谢秀霞. 穴位注射并中药腹部热敷对腹部术后胃肠功能的影响. 世界华人消化杂志, 2010, 18(20): 2146-2149.
26.	佘凤华. 小茴香治疗剖宫产术后腹胀的疗效观察. 现代临床医学, 2010, 36(4): 303.
27.	朱利利, 杨丽明, 刘秋萍, 等. 足三里穴位埋线促进腹部术后胃肠功能恢复的效果研究. 中国医药导报, 2010, 7(18): 25-26.
28.	Robertson N, Gallacher PJ, Peel N, et al. Implementation of an enhanced recovery programme following pancreaticoduodenectomy. HPB (Oxford), 2012, 14(10): 700-708.
29.	Servicl-Kuchler D, Maldini B, Borgeat A, et al. The influence of postoperative epidural analgesia on postoperative pain and stress response after major spine surgery－a randomized controlled double blind study. Acta Clin Croat, 2014, 53(2): 176-183.
30.	Rawal N. Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med, 2012, 37(3): 310-317.
31.	Pratt WB, Steinbrook RA, Maithel SK, et al. Epidural analgesia for pancreatoduodenectomy: a critical appraisal. J Gastrointest Surg, 2008, 12(7): 1207-1220.
32.	Pratt WB, Steinbrook RA, Maithel SK, et al. Epidural analgesia for pancreatoduodenectomy: a critical appraisal. J Gastrointest Surg, 2008, 12(7): 1207-1220.
33.	Zhu Y, Wang S, Wu H, et al. Effect of perioperative parecoxib on postoperative pain and local inflammation factors PGE2 and IL-6 for total knee arthroplasty: a randomized, double-blind, placebo-controlled study. Eur J Orthop Surg Traumatol, 2014, 24(3): 395-401.
34.	Gan TJ, Joshi GP, Zhao SZ, et al. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand, 2004, 48(9): 1194-1207.

1. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
2. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
3. Bu J, Li N, Huang X, et al. Feasibility of fast-track surgery in elderly patients with gastric cancer. J Gastrointest Surg, 2015, 19(8): 1391-1398.
4. Dorcaratto D, Grande L, Pera M. Enhanced recovery in gastrointestinal surgery: upper gastrointestinal surgery. Dig Surg, 2013, 30(1): 70-78.
5. Karran A, Wheat J, Chan D, et al. Propensity score analysis of an enhanced recovery programme in upper gastrointestinal cancer surgery. World J Surg, 2016, 40(7): 1645-1654.
6. Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford), 2014, 16(8): 699-706.
7. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
8. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
9. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
10. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
11. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
12. Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
13. 中国研究型医院学会肝胆胰外科专业委员会; 董家鸿, 梁延波. 中国肝胆胰外科术后加速康复外科专家共识. 中华消化外科杂志, 2015, 15(1): 1-6.
14. 中国加速康复外科专家组; 赵玉沛. 中国加速康复外科围手术期管理专家共识. 中华外科杂志, 2016, 54(6): 413-418.
15. Dai J, Jiang Y, Fu D. Reducing postoperative complications and improving clinical outcome: enhanced recovery after surgery in pancreaticoduodenectomy －a retrospective cohort study. Int J Surg, 2017, 39: 176-181.
16. Xiong J, Szatmary P, Huang W, et al. Enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2016, 95(18): e3497.
17. Zausig YA, Weigand MA, Graf BM. Perioperative fluid management: an analysis of the present situation. Anaesthesist, 2006, 55(4): 371-390.
18. Goonetilleke KS, Siriwardena AK. Systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy. JOP, 2006, 7(1): 5-13.
19. Pappas S, Krzywda E, McDowell N. Nutrition and pancreaticoduodenectomy. Nutr Clin Pract, 2010, 25(3): 234-243.
20. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev, 2007, (3): CD004929.
21. Bauer VP. The evidence against prophylactic nasogastric intubation and oral restriction. Clin Colon Rectal Surg, 2013, 26(3): 182-185.
22. Coolsen MM, van Dam RM, Chigharoe A, et al. Improving outcome after pancreaticoduodenectomy: experiences with implementing an enhanced recovery after surgery (ERAS) program. Dig Surg, 2014, 31(3): 177-184.
23. Braga M, Pecorelli N, Ariotti R, et al. Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J Surg, 2014, 38(11): 2960-2966.
24. di Sebastiano P, Festa L, De Bonis A, et al. A modified fast-track program for pancreatic surgery: a prospective single-center experience. Langenbecks Arch Surg, 2011, 396(3): 345-351.
25. 陈月琴, 任迎彬, 谢秀霞. 穴位注射并中药腹部热敷对腹部术后胃肠功能的影响. 世界华人消化杂志, 2010, 18(20): 2146-2149.
26. 佘凤华. 小茴香治疗剖宫产术后腹胀的疗效观察. 现代临床医学, 2010, 36(4): 303.
27. 朱利利, 杨丽明, 刘秋萍, 等. 足三里穴位埋线促进腹部术后胃肠功能恢复的效果研究. 中国医药导报, 2010, 7(18): 25-26.
28. Robertson N, Gallacher PJ, Peel N, et al. Implementation of an enhanced recovery programme following pancreaticoduodenectomy. HPB (Oxford), 2012, 14(10): 700-708.
29. Servicl-Kuchler D, Maldini B, Borgeat A, et al. The influence of postoperative epidural analgesia on postoperative pain and stress response after major spine surgery－a randomized controlled double blind study. Acta Clin Croat, 2014, 53(2): 176-183.
30. Rawal N. Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med, 2012, 37(3): 310-317.
31. Pratt WB, Steinbrook RA, Maithel SK, et al. Epidural analgesia for pancreatoduodenectomy: a critical appraisal. J Gastrointest Surg, 2008, 12(7): 1207-1220.
32. Pratt WB, Steinbrook RA, Maithel SK, et al. Epidural analgesia for pancreatoduodenectomy: a critical appraisal. J Gastrointest Surg, 2008, 12(7): 1207-1220.
33. Zhu Y, Wang S, Wu H, et al. Effect of perioperative parecoxib on postoperative pain and local inflammation factors PGE2 and IL-6 for total knee arthroplasty: a randomized, double-blind, placebo-controlled study. Eur J Orthop Surg Traumatol, 2014, 24(3): 395-401.
34. Gan TJ, Joshi GP, Zhao SZ, et al. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand, 2004, 48(9): 1194-1207.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of multi-subjects and multi-modes intervention in the enhanced recovery afterpancreaticoduodenectomy

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