Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Christoph Kuemmerli, Gianpaolo Balzano, Stefan A. Bouwense, Marco Braga, Mariëlle Coolsen, Sara K. Daniel, Christos Dervenis, Massimo Falconi, Dae Wook Hwang, Daniel J. Kagedan, Song Cheol Kim, Harish Lavu, Daniel Nussbaum, Stefano Partelli, Michael J. Passeri, Nicolò Pecorelli, Venu G. Pillarisetty, Michael J. Pucci, Robert P. Sutcliffe, Bobby Tingstedt, Marion van der Kolk, Dionisios Vrochides, Misha Armstrong, Alice Wei, Caroline Williamsson, Charles J. Yeo, Sabino Zani, Efstratios Zouros, Renzo Rozzini, Mohammed Abu Hilal
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引用次数: 0

Abstract

Background

This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD).

Methods

Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age-dependent effect, the group was divided in septuagenarians (70–79 years) and older patients (≥80 years).

Results

IPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major complication rates were comparable in both groups (OR 0.92 [95% CI: 0.65–1.29], p = .596 and OR 1.22 [95% CI: 0.61–2.46], p = .508). Length of hospital stay tended to be shorter in the ERAS group compared to the conventional care group (−0.14 days [95% CI: −0.29 to 0.01], p = .071) while readmission rates were comparable and the total length of stay including days in hospital after readmission tended to be shorter in the ERAS group (−0.28 days [95% CI: −0.62 to 0.05], p = .069). In the subgroups, the length of stay was shorter in octogenarians treated with ERAS (−0.36 days [95% CI: −0.71 to −0.004], p = .048). The readmission rate increased slightly but not significantly while the total length of stay was not longer in the ERAS group.

Conclusion

ERAS in the elderly is safe and its benefits are preserved in the care of even in patients older than 80 years. Standardized care protocol should be encouraged in all pancreatic centers.

Abstract Image

胰十二指肠切除术后的强化恢复方案应用于老年患者是否仍然有效?系统综述和个体患者数据荟萃分析。
背景:这项荟萃分析研究了与传统护理相比,术后恢复强化方案(ERAS)对 70 岁及以上接受胰十二指肠切除术(PD)患者术后效果的影响:方法:系统检索了五个数据库。方法:对五个数据库进行了系统检索,纳入了具有患者个人数据(IPD)的比较研究。主要结果包括术后发病率、住院时间、再入院率和术后功能恢复要素。为评估年龄依赖效应,研究组分为七旬老人(70-79 岁)和老年患者(≥80 岁):在 31 项符合条件的研究中,有 15 项获得了 IPD,共有 1109 名患者。两组患者的总体并发症和主要并发症发生率相当(OR 0.92 [95% CI: 0.65-1.29], p = .596 和 OR 1.22 [95% CI: 0.61-2.46], p = .508)。与传统护理组相比,ERAS 组的住院时间往往更短(-0.14 天 [95% CI:-0.29 至 0.01],p = .071),而ERAS 组的再入院率相当,总住院时间(包括再入院后的住院天数)往往更短(-0.28 天 [95% CI:-0.62 至 0.05],p = .069)。在亚组中,接受ERAS治疗的八旬老人的住院时间更短(-0.36天[95% CI:-0.71至-0.004],P = .048)。ERAS组的再入院率略有增加,但不明显,而总住院时间没有延长:结论:ERAS对老年人是安全的,即使是对80岁以上的患者,其优点在护理中也能得到保留。所有胰腺中心都应鼓励采用标准化护理方案。
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来源期刊
Journal of Hepato‐Biliary‐Pancreatic Sciences
Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY
自引率
10.00%
发文量
178
审稿时长
6-12 weeks
期刊介绍: The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.
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