Key result
There was no significant difference in overall complication rates between the early and late ERAS cohorts (40% vs 38.7%, P=0.8), and median length of stay remained unchanged.
Why the study?
Does the timing of ERAS protocol implementation ('early' vs 'late' cohort) improve postoperative outcomes in patients undergoing hepatectomy and pancreatectomy?
Cohort (n=99)
No
Does the timing of ERAS protocol implementation ('early' vs 'late' cohort) improve postoperative outcomes in patients undergoing hepatectomy and pancreatectomy?
Absolute Event Rate: 40% vs 38.7%
p-value: p=0.8
In patients undergoing hepatectomy and pancreatectomy, adherence to an ERAS protocol did not improve median length of stay over time, with surgery-related complications being the main reason for noncompliance.
No outcome differences by ERAS implementation timing; leaves open whether adherence or other factors drive results in hepatopancreatic surgery.
Background and Aim Enhanced recovery after surgery (ERAS) protocols are reported to improve postoperative outcomes in patients undergoing a routine protocol and postoperative outcomes in patients undergoing hepatic and pancreatic resections at our institution. Methods A total of 99 consecutive patients at a single institution managed with a similar ERAS protocol were divided into the “early” (50 patients) and “late” (49 patients) cohorts. Both cohorts were statistically identical in demographics and range of surgical procedures performed. Postoperative complications, readmission, reoperation rates, and length of stay were analyzed. Categorical variables were statistically compared using Fisher's exact test and continuous variables using t‐test and Mann–Whitney U‐test when appropriate. Results There were 32 hepatectomies/18 pancreatectomies in the “early” cohort and 22 hepatectomies/29 pancreatectomies in the “late” cohort. The overall complication rate was 38.8%, with a 30‐day readmission rate and reoperation rate of 16.1 and 5%, respectively. There was one mortality (1%). Group‐specific overall complication rate (40 vs 38.7%, P = 0.8), readmission rate (20 vs 12.2%, P = 0.4), reoperation rate (6 vs 4%, P = 1.0), and mortality (2 vs 0%, P = 1.0) were not statistically significant between both groups. Conclusions Despite similar rates of adherence to the established ERAS 24 protocol, there was no improvement in median length of stay (7 days) between the “early” and “late” groups. The only reason for noncompliance with the ERAS protocol was development of surgery‐related complications.
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Philip et al. (2019) conducted a cohort in Hepatectomy and pancreatectomy (n=99). Early ERAS cohort vs. Late ERAS cohort was evaluated on Overall complication rate (p=0.8). There was no significant difference in overall complication rates between the early and late ERAS cohorts (40% vs 38.7%, P=0.8), and median length of stay remained unchanged.
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