Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations
Kristoffer Lassen,Kristoffer Lassen,Marielle M.E. Coolsen,Karem Slim,Francesco Carli,José Eduardo de Aguilar-Nascimento,Markus Schäfer,Rowan W. Parks,Kenneth C. H. Fearon,Dileep N. Lobo,Nicolas Demartines,Marco Braga,Olle Ljungqvist,Olle Ljungqvist,Cornelis H. C. Dejong +14 more
TLDR
Evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy and facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.Abstract:
Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. An international working group constructed within the Enhanced Recovery After Surgery (ERAS®) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated “high”, “moderate”, “low” or “very low”. Recommendations were graded as “strong” or “weak”. Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.read more
Citations
More filters
Journal ArticleDOI
Early Versus Late Oral Refeeding After Pancreaticoduodenectomy for Malignancy: a Comparative Belgian-French Study in Two Tertiary Centers.
Julie Navez,Julie Navez,Catherine Hubert,Safi Dokmak,Isadora Frick De La Maza,Nicolas Tabchouri,Olivier Benoit,Hélène Hermand,Francis Zech,Jean-François Gigot,Alain Sauvanet +10 more
TL;DR: Early postoperative oral feeding after PD was associated with a shorter hospital stay and did not increase severe postoperative morbidity or the rate of pancreatic fistula, however, it resulted in more chyle leaks anddid not prevent delayed gastric emptying.
Journal ArticleDOI
Correlation of postoperative fluid balance and weight and their impact on outcomes.
TL;DR: POD 2 weight may represent an easy and pragmatic tool to optimize fluid management and help to prevent fluid-related postoperative complications.
Journal ArticleDOI
Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial
Wataru Nakanishi,Shigehito Miyagi,Kazuaki Tokodai,Atsushi Fujio,Kengo Sasaki,Yoshihiro Shono,Michiaki Unno,Takashi Kamei +7 more
TL;DR: This trial did not demonstrate greater efficacy of the ERAS protocol following open hepatectomy in terms of the MFD and LOHS, however, the ERas protocol was associated with better recovery from postoperative gastrointestinal paresis, suggesting that it is useful for patients undergoing open hepATEctomy.
Journal ArticleDOI
Lessons learned from 300 consecutive pancreaticoduodenectomies over a 25-year experience: the “safety net” improves the outcomes beyond surgeon skills
Roberto Santoro,Roberto Luca Meniconi,Pasquale Lepiane,Giovanni Vennarecci,Gianluca Mascianà,Marco Colasanti,Eugenio Santoro,Giuseppe Maria Ettorre +7 more
TL;DR: Evaluating the importance of surgical and hospital experience on outcomes by comparing postoperative results in three different hospitals with increasing resources for supporting the same surgical team found that a multidisciplinary pancreatic team represents the “safety net” of pancreatic surgeon because it improves the results beyond the surgeon skills and experience.
References
More filters
Journal ArticleDOI
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Gordon H. Guyatt,Andrew D Oxman,Gunn Elisabeth Vist,Regina Kunz,Yngve Falck-Ytter,Pablo Alonso-Coello,Holger J. Schünemann +6 more
TL;DR: The advantages of the GRADE system are explored, which is increasingly being adopted by organisations worldwide and which is often praised for its high level of consistency.
Journal ArticleDOI
Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe,Pieter Wouters,Frank Weekers,Charles Verwaest,Frans Bruyninckx,Miet Schetz,Dirk Vlasselaers,Patrick Ferdinande,Peter Lauwers,Roger Bouillon +9 more
TL;DR: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
Journal ArticleDOI
Audit and feedback: effects on professional practice and healthcare outcomes
Noah Ivers,Gro Jamtvedt,Signe Flottorp,Jane M. Young,Jan Odgaard-Jensen,Simon D. French,Mary Ann O’Brien,Marit Johansen,Jeremy M. Grimshaw,Andrew D Oxman +9 more
TL;DR: The results indicated that feedback may be more effective when baseline performance is low, the source is a supervisor or colleague, it is provided more than once, and the role of context and the targeted clinical behaviour was assessed.
Journal ArticleDOI
What is a randomised controlled trial
Andrea Cipriani,John R. Geddes +1 more
TL;DR: The Consolidated Statement of Reporting Trials (CONSORT) provides readers of RCTs with a list of criteria useful to assess trial validity (for full details visit www.consortstatement.org).
Journal ArticleDOI
Prevention of venous thromboembolism
Willitim Geerts,Joel C. Ray,Clifford W. Colwell,David Bergqvist,Graham F. Pineo,M. R. Lassen,John A. Heit +6 more
TL;DR: The risk factors for VTE among hospitalized patients are outlined, the efficacy and safety of alternative prophylaxis regimens are reviewed, and recommendations regarding the most suitable prophymic regimens based on the estimated risk are provided.