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Erschienen in: World Journal of Surgery 1/2015

01.01.2015 | Original Scientific Report

Implementing an Enhanced Recovery Program After Pancreaticoduodenectomy in Elderly Patients: Is It Feasible?

verfasst von: Mariëlle M. E. Coolsen, Maikel Bakens, Ronald M. van Dam, Steven W. M. Olde Damink, Cornelis H. C. Dejong

Erschienen in: World Journal of Surgery | Ausgabe 1/2015

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Abstract

Background

An enhanced recovery after surgery (ERAS) program aims to reduce the stress response to surgery and thereby accelerate recovery. It is unclear whether these programs can be safely implemented for elderly patients, especially in highly complex surgery such as pancreaticoduodenectomy (PD). The objective of this study was to evaluate the feasibility of an ERAS program in elderly patients undergoing PD.

Methods

Implementation of the ERAS protocol was studied prospectively in a consecutive series of patients undergoing PD between January 2009 and August 2013. Patients were divided into two groups: ≤65 years and ≥70 years. Endpoints were length of stay (LOS), readmissions, morbidity, mortality, and compliance with ERAS targets.

Results

Of a total of 110 patients, 55 were ≤65 years (median 57) and 55 ≥ 70 years (median 77). Median LOS was 14 days in both groups. In patients without complications median LOS was 9 days. Both mortality and readmissions did not differ between groups (mortality n = 3 (5.5 %) in younger versus n = 6 (10.9 %) in older patients, p = 0.49, readmissions: n = 11 (20 %) versus n = 7 (12.7 %), p = 0.44). CT-drainage and relaparotomy-rates were not different between groups, nor was overall morbidity (n = 31 (56.3 %) in the older versus n = 35 (63.3 %) in the younger group, p = 0.44). There were no differences in compliance with elements of the ERAS protocol between groups.

Conclusion

An ERAS program seems feasible and safe for patients ≥70 years of age undergoing PD.
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Literatur
1.
Zurück zum Zitat Centre DC (2011) National guidlines “pancreatic carcinoma” version 2.0. Utrecht Centre DC (2011) National guidlines “pancreatic carcinoma” version 2.0. Utrecht
2.
Zurück zum Zitat Kow AW, Sadayan NA, Ernest A et al (2012) Is pancreaticoduodenectomy justified in elderly patients? Surgeon 10(3):128–136PubMedCrossRef Kow AW, Sadayan NA, Ernest A et al (2012) Is pancreaticoduodenectomy justified in elderly patients? Surgeon 10(3):128–136PubMedCrossRef
3.
Zurück zum Zitat Ito Y, Kenmochi T, Irino T et al (2011) The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol 9:102PubMedCentralPubMedCrossRef Ito Y, Kenmochi T, Irino T et al (2011) The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol 9:102PubMedCentralPubMedCrossRef
4.
Zurück zum Zitat Scurtu R, Bachellier P, Oussoultzoglou E et al (2006) Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg 10(6):813–822PubMedCrossRef Scurtu R, Bachellier P, Oussoultzoglou E et al (2006) Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg 10(6):813–822PubMedCrossRef
5.
Zurück zum Zitat Tani M, Kawai M, Hirono S et al (2009) A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age. J Hepatobiliary Pancreat Surg 16(5):675–680PubMedCrossRef Tani M, Kawai M, Hirono S et al (2009) A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age. J Hepatobiliary Pancreat Surg 16(5):675–680PubMedCrossRef
6.
Zurück zum Zitat Suzuki S, Kaji S, Koike N et al (2013) Pancreaticoduodenectomy can be safely performed in the elderly. Surg Today 43(6):620–624PubMedCrossRef Suzuki S, Kaji S, Koike N et al (2013) Pancreaticoduodenectomy can be safely performed in the elderly. Surg Today 43(6):620–624PubMedCrossRef
8.
Zurück zum Zitat Podore PC, Throop EB (1999) Infrarenal aortic surgery with a 3-day hospital stay: a report on success with a clinical pathway. J Vasc Surg 29(5):787–792PubMedCrossRef Podore PC, Throop EB (1999) Infrarenal aortic surgery with a 3-day hospital stay: a report on success with a clinical pathway. J Vasc Surg 29(5):787–792PubMedCrossRef
9.
Zurück zum Zitat Arsalani-Zadeh R, ElFadl D, Yassin N et al (2011) Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg 98(2):181–196PubMedCrossRef Arsalani-Zadeh R, ElFadl D, Yassin N et al (2011) Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg 98(2):181–196PubMedCrossRef
10.
11.
Zurück zum Zitat Varadhan KK, Neal KR, Dejong CH et al (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29(4):434–440PubMedCrossRef Varadhan KK, Neal KR, Dejong CH et al (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29(4):434–440PubMedCrossRef
12.
Zurück zum Zitat Coolsen MMD RM, de Wilt AA, Lassen K, Slim K, Dejong CHC (2013) Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg 37(9):1909–1918. doi:10.1007/s00268-013-2044-3 CrossRef Coolsen MMD RM, de Wilt AA, Lassen K, Slim K, Dejong CHC (2013) Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg 37(9):1909–1918. doi:10.​1007/​s00268-013-2044-3 CrossRef
13.
14.
Zurück zum Zitat Wind J, Polle SW, Fung Kon Jin PH et al (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93(7):800–809PubMedCrossRef Wind J, Polle SW, Fung Kon Jin PH et al (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93(7):800–809PubMedCrossRef
15.
Zurück zum Zitat Balzano G, Zerbi A, Braga M et al (2008) Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying. Br J Surg 95(11):1387–1393PubMedCrossRef Balzano G, Zerbi A, Braga M et al (2008) Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying. Br J Surg 95(11):1387–1393PubMedCrossRef
16.
Zurück zum Zitat Porter GA, Pisters PW, Mansyur C et al (2000) Cost and utilization impact of a clinical pathway for patients undergoing pancreaticoduodenectomy. Ann Surg Oncol 7(7):484–489PubMedCrossRef Porter GA, Pisters PW, Mansyur C et al (2000) Cost and utilization impact of a clinical pathway for patients undergoing pancreaticoduodenectomy. Ann Surg Oncol 7(7):484–489PubMedCrossRef
17.
Zurück zum Zitat di Sebastiano P, Festa L, De Bonis A et al (2011) A modified fast-track program for pancreatic surgery: a prospective single-center experience. Langenbecks Arch Surg 396(3):345–351PubMedCrossRef di Sebastiano P, Festa L, De Bonis A et al (2011) A modified fast-track program for pancreatic surgery: a prospective single-center experience. Langenbecks Arch Surg 396(3):345–351PubMedCrossRef
18.
Zurück zum Zitat Lassen K, Coolsen MM, Slim K et al (2012) Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clin Nutr 31(6):817–830PubMedCrossRef Lassen K, Coolsen MM, Slim K et al (2012) Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clin Nutr 31(6):817–830PubMedCrossRef
19.
Zurück zum Zitat Hamel MB, Henderson WG, Khuri SF et al (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53(3):424–429PubMedCrossRef Hamel MB, Henderson WG, Khuri SF et al (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53(3):424–429PubMedCrossRef
20.
Zurück zum Zitat Gouvas N, Tan E, Windsor A et al (2009) Fast-track versus standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24(10):1119–1131PubMedCrossRef Gouvas N, Tan E, Windsor A et al (2009) Fast-track versus standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24(10):1119–1131PubMedCrossRef
21.
Zurück zum Zitat Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132PubMedCrossRef Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132PubMedCrossRef
22.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13PubMedCrossRef Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13PubMedCrossRef
23.
Zurück zum Zitat Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768PubMedCrossRef Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768PubMedCrossRef
24.
Zurück zum Zitat Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensiv Care Med 29(4):530–538CrossRef Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensiv Care Med 29(4):530–538CrossRef
25.
Zurück zum Zitat Welsch T, Eisele H, Zschabitz S et al (2011) Critical appraisal of the International Study Group of Pancreatic Surgery (ISGPS) consensus definition of postoperative hemorrhage after pancreatoduodenectomy. Langenbecks Arch Surg 396(6):783–791PubMedCrossRef Welsch T, Eisele H, Zschabitz S et al (2011) Critical appraisal of the International Study Group of Pancreatic Surgery (ISGPS) consensus definition of postoperative hemorrhage after pancreatoduodenectomy. Langenbecks Arch Surg 396(6):783–791PubMedCrossRef
26.
Zurück zum Zitat Maher JW, Bakhos W, Nahmias N et al (2009) Drain amylase levels are an adjunct in detection of gastrojejunostomy leaks after Roux-en-Y gastric bypass. J Am Coll Surg 208(5):881–884PubMedCrossRef Maher JW, Bakhos W, Nahmias N et al (2009) Drain amylase levels are an adjunct in detection of gastrojejunostomy leaks after Roux-en-Y gastric bypass. J Am Coll Surg 208(5):881–884PubMedCrossRef
27.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCentralPubMedCrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCentralPubMedCrossRef
28.
Zurück zum Zitat Sukharamwala P, Thoens J, Szuchmacher M et al (2012) Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB 14(10):649–657PubMedCrossRef Sukharamwala P, Thoens J, Szuchmacher M et al (2012) Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB 14(10):649–657PubMedCrossRef
29.
Zurück zum Zitat Makary MA, Winter JM, Cameron JL et al (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10(3):347–356PubMedCrossRef Makary MA, Winter JM, Cameron JL et al (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10(3):347–356PubMedCrossRef
30.
Zurück zum Zitat Sohn TA, Yeo CJ, Cameron JL et al (1998) Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 2(3):207–216PubMedCrossRef Sohn TA, Yeo CJ, Cameron JL et al (1998) Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 2(3):207–216PubMedCrossRef
32.
Zurück zum Zitat Brozzetti S, Mazzoni G, Miccini M et al (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141(2):137–142PubMedCrossRef Brozzetti S, Mazzoni G, Miccini M et al (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141(2):137–142PubMedCrossRef
33.
Zurück zum Zitat Hodul P, Tansey J, Golts E et al (2001) Age is not a contraindication to pancreaticoduodenectomy. Am Surg 67(3):270–275PubMed Hodul P, Tansey J, Golts E et al (2001) Age is not a contraindication to pancreaticoduodenectomy. Am Surg 67(3):270–275PubMed
34.
Zurück zum Zitat Finlayson E, Fan Z, Birkmeyer JD (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205(6):729–734PubMedCrossRef Finlayson E, Fan Z, Birkmeyer JD (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205(6):729–734PubMedCrossRef
35.
Zurück zum Zitat Riall TS, Reddy DM, Nealon WH et al (2008) The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 248(3):459–467PubMedCentralPubMed Riall TS, Reddy DM, Nealon WH et al (2008) The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 248(3):459–467PubMedCentralPubMed
36.
Zurück zum Zitat de Wilde RF, Besselink MG, van der Tweel I et al (2012) Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 99(3):404–410PubMedCrossRef de Wilde RF, Besselink MG, van der Tweel I et al (2012) Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 99(3):404–410PubMedCrossRef
37.
Zurück zum Zitat Fiore JF Jr, Faragher IG, Bialocerkowski A et al (2013) Time to readiness for discharge is a valid and reliable measure of short-term recovery after colorectal surgery. World J Surg 37(12):2927–2934. doi:10.1007/s00268-013-2208-1 PubMedCrossRef Fiore JF Jr, Faragher IG, Bialocerkowski A et al (2013) Time to readiness for discharge is a valid and reliable measure of short-term recovery after colorectal surgery. World J Surg 37(12):2927–2934. doi:10.​1007/​s00268-013-2208-1 PubMedCrossRef
40.
Zurück zum Zitat Ahmed J, Khan S, Gatt M et al (2010) Compliance with enhanced recovery programmes in elective colorectal surgery. Br J Surg 97(5):754–758PubMedCrossRef Ahmed J, Khan S, Gatt M et al (2010) Compliance with enhanced recovery programmes in elective colorectal surgery. Br J Surg 97(5):754–758PubMedCrossRef
41.
Zurück zum Zitat Nicholson A, Lowe MC, Parker J et al (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101(3):172–188PubMedCrossRef Nicholson A, Lowe MC, Parker J et al (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101(3):172–188PubMedCrossRef
42.
Zurück zum Zitat Bassi C, Molinari E, Malleo G et al (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252(2):207–214PubMedCrossRef Bassi C, Molinari E, Malleo G et al (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252(2):207–214PubMedCrossRef
43.
Zurück zum Zitat Kawai M, Tani M, Terasawa H et al (2006) Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 244(1):1–7PubMedCentralPubMedCrossRef Kawai M, Tani M, Terasawa H et al (2006) Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 244(1):1–7PubMedCentralPubMedCrossRef
44.
Zurück zum Zitat Conlon KC, Labow D, Leung D et al (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234(4):487–493PubMedCentralPubMedCrossRef Conlon KC, Labow D, Leung D et al (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234(4):487–493PubMedCentralPubMedCrossRef
45.
Zurück zum Zitat Van Buren G 2nd, Bloomston M, Hughes SJ et al (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259(4):605–612PubMedCrossRef Van Buren G 2nd, Bloomston M, Hughes SJ et al (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259(4):605–612PubMedCrossRef
46.
Zurück zum Zitat Al-Sharaf K, Andren-Sandberg A, Ihse I (1999) Subtotal pancreatectomy for cancer can be safe in the elderly. Eur J Surg (Acta chirurgica) 165(3):230–235CrossRef Al-Sharaf K, Andren-Sandberg A, Ihse I (1999) Subtotal pancreatectomy for cancer can be safe in the elderly. Eur J Surg (Acta chirurgica) 165(3):230–235CrossRef
47.
Zurück zum Zitat Fong Y, Blumgart LH, Fortner JG et al (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222(4):426–434PubMedCentralPubMedCrossRef Fong Y, Blumgart LH, Fortner JG et al (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222(4):426–434PubMedCentralPubMedCrossRef
48.
Zurück zum Zitat Bottger TC, Engelmann R, Junginger T (1999) Is age a risk factor for major pancreatic surgery? An analysis of 300 resections. Hepatogastroenterology 46(28):2589–2598PubMed Bottger TC, Engelmann R, Junginger T (1999) Is age a risk factor for major pancreatic surgery? An analysis of 300 resections. Hepatogastroenterology 46(28):2589–2598PubMed
49.
Zurück zum Zitat Kurian AA, Wang L, Grunkemeier G et al (2013) Defining “the elderly” undergoing major gastrointestinal resections: receiver operating characteristic analysis of a large ACS-NSQIP cohort. Ann Surg 258(3):483–489PubMedCrossRef Kurian AA, Wang L, Grunkemeier G et al (2013) Defining “the elderly” undergoing major gastrointestinal resections: receiver operating characteristic analysis of a large ACS-NSQIP cohort. Ann Surg 258(3):483–489PubMedCrossRef
50.
Zurück zum Zitat Junejo MA, Mason JM, Sheen AJ et al (2012) Cardiopulmonary exercise testing for preoperative risk assessment before hepatic resection. Br J Surg 99(8):1097–1104PubMedCrossRef Junejo MA, Mason JM, Sheen AJ et al (2012) Cardiopulmonary exercise testing for preoperative risk assessment before hepatic resection. Br J Surg 99(8):1097–1104PubMedCrossRef
51.
Zurück zum Zitat Gouma DJ, van Geenen RC, van Gulik TM et al (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232(6):786–795PubMedCentralPubMedCrossRef Gouma DJ, van Geenen RC, van Gulik TM et al (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232(6):786–795PubMedCentralPubMedCrossRef
52.
Zurück zum Zitat Balzano G, Zerbi A, Capretti G et al (2008) Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg 95(3):357–362PubMedCrossRef Balzano G, Zerbi A, Capretti G et al (2008) Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg 95(3):357–362PubMedCrossRef
Metadaten
Titel
Implementing an Enhanced Recovery Program After Pancreaticoduodenectomy in Elderly Patients: Is It Feasible?
verfasst von
Mariëlle M. E. Coolsen
Maikel Bakens
Ronald M. van Dam
Steven W. M. Olde Damink
Cornelis H. C. Dejong
Publikationsdatum
01.01.2015
Verlag
Springer US
Erschienen in
World Journal of Surgery / Ausgabe 1/2015
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-014-2782-x

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