Analysis of results after the implementation of fast recovery protocols in hepatopancreatobiliary surgery

  • Juan Pablo Aristizábal Clínica CES, Medellín, Colombia
  • José Julián Estrada Clínica CES, Medellín, Colombia
  • Ana Sofía Arango Universidad CES, Medellín, Colombia.
  • Paola Sánchez-Zapata Clínica CES, Medellín, Colombia
Keywords: Pancreatectomy, Hepatectomy, Mortality, Morbidity, Anesthesia Recovery Period

Abstract

Background:

Hepatopancreatobiliary surgery (HPB) has been able to reduce morbidity and mortality over the past 30 years, as a result of technological breakthroughs, high-volume centers, and the implementation of multidisciplinary groups with fast recovery protocols.

Objective:

To compare the impact of implementing fast recovery guidelines in patients undergoing HPB surgery.

Methods:

We conducted an observational retrospective study collecting medical records of patients undergoing HPB surgery from July 2012 to January 2017. An analysis was done of the demographic data, frequent diagnoses, fluid therapy, need for transfusions, length of hospital stay, need for reintervention, and 30-day mortality. Two groups were identified: group A (July 2012-December 2014) and group B (January 2015-January 2017) in which fast recovery protocols were implemented.

Results:

A total of 364 patients were included, 145 in group A and 219 in group B. The most frequent diagnoses were pancreatic cancer, liver metastasis, cholangiocarcinoma, and bile duct injury. Bleeding was less than 600 mL (OR = 12,88, CI 95%(5,3131,23)), the transfusion requirements dropped (OR=0.16; 95% CI: 0.068-0.418), and fluid therapy was below 5000 mL in group B (OR = 4.23; 95% CI: 1.76-10.11). Length of hospital stay was 3 days (interquartile range 2-5; p<0.001), and mortality at 30 days was lower in group B (p = 0.012).

Conclusion:

The implementation of fast recovery protocols showed a decrease in intraoperative bleeding, intravenous fluids therapy, length of hospital stay, and 30-day mortality.

References

1. Foster JH. History of liver surgery. Arch Surg 1960-1991;126:381-387.

2. Lassen K, Coolsen MME, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg 2013; 37:240-258.

3. De Pietri L, Montalti R, Begliomini B. Anaesthetic perioperative management of patients with pancreatic cancer. World J Gastroenterol 2014;20:2304-2320.

4. Snowden C, Prentis J. Anesthesia for hepatobiliary surgery. Anesthesiol Clin 2015;33:125-141.

5. Jones C, Kelliher L, Thomas R, et al. Perioperative management of liver resection surgery. J Perioper Pract 2011;21:198-202.

6. Edwin B, Nordin A, Kazaryan AM. Laparoscopic liver surgery: new frontiers. Scand J Surg 2011;100:54-65.

7. Dokmak S, Ftériche FS, Borscheid R, et al. 2012 Liver resections in the 21st century: we are far from zero mortality. HPB 2013;15:908-915.

8. Song W, Wang K, Zhang R-J, et al. The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. SpringerPlus 2016;5:207.

9. Wang C, Zheng G, Zhang W, et al. Enhanced recovery after surgery programs for liver resection: a meta-analysis. J Gastrointest Surg 2017;21:472-486.

10. Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB 2014;16:699-706.

11. Zhao Y, Qin H, Wu Y, et al. Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017;96:e7628.

12. Are C, Dhir M, Ravipati L. History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers. HPB 2011;13:377-384.

13. Kagedan DJ, Ahmed M, Devitt KS, et al. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB 2015;17:11-16.

14. Kobayashi S, Ooshima R, Koizumi S, et al. Perioperative care with fast-track management in patients undergoing pancreaticoduodenectomy. World J Surg 2014;38:2430-2437. [ Links ]

15. 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:e3497.

16. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg 2017;152:292-298.

17. Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 2016;40:2425-2440.

18. Visioni A, Shah R, Gabriel E, et al. Enhanced recovery after surgery for noncolorectal surgery?: A systematic review and metaanalysis of major abdominal surgery. Ann Surg 2018;267:57-65.

19. Scott MJ, Miller TE. Pathophysiology of major surgery and the role of enhanced recovery pathways and the anesthesiologist to improve outcomes. Anesthesiol Clin 2015;33:79-91. [ Links ]

20. Jones C, Kelliher L, Dickinson M, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg 2013;100:1015-1024.

21. Joliat G-R, Labgaa I, Hübner M, et al. Cost-benefit analysis of the implementation of an enhanced recovery program in liver surgery. World J Surg 2016;40:2441-2450.

22. Brandstrup B, T0nnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003;238:641-648.

23. Gan TJ, Soppitt A, Maroof M, et al. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002;97:820-826.

24. Kulemann B, Fritz M, Glatz T, et al. Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: a single center retrospective cohort study. Ann Med Surg 2012-2017;16:23-29.

25. Voldby AW, Brandstrup B. Fluid therapy in the perioperative setting-a clinical review. J Intensive Care 2016;4:27.

26. Mythen MG, Swart M, Acheson N, et al. Perioperative fluid management: consensus statement from the enhanced recovery partnership. Perioper Med 2012;1:2.

27. Cannesson M, Ramsingh D, Rinehart J, et al. Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study. Crit Care 2015;19:261.

28. Navarro LHC, Bloomstone JA, Auler JOC, et al. Perioperative fluid therapy: a statement from the international Fluid Optimization Group. Perioper Med 2015;4:3.

29. Benes J, Giglio M, Brienza N, et al. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care 2014; 18:584.
How to Cite
1.
Aristizábal JP, Estrada JJ, Arango AS, Sánchez-Zapata P. Analysis of results after the implementation of fast recovery protocols in hepatopancreatobiliary surgery. Colomb. J. Anesthesiol. [Internet]. 2018Jul.1 [cited 2022Aug.14];46(3):196-02. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/516

Downloads

Download data is not yet available.
Published
2018-07-01
How to Cite
1.
Aristizábal JP, Estrada JJ, Arango AS, Sánchez-Zapata P. Analysis of results after the implementation of fast recovery protocols in hepatopancreatobiliary surgery. Colomb. J. Anesthesiol. [Internet]. 2018Jul.1 [cited 2022Aug.14];46(3):196-02. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/516
Section
Original

More on this topic