Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis.
Author
Kuemmerli, ChristophBalzano, Gianpaolo
Bouwense, Stefan A
Braga, Marco
Coolsen, Mariëlle
Daniel, Sara K
Dervenis, Christos
Falconi, Massimo
Hwang, Dae Wook
Kagedan, Daniel J
Kim, Song Cheol
Lavu, Harish
Nussbaum, Daniel
Partelli, Stefano
Passeri, Michael J
Pecorelli, Nicolò
Pillarisetty, Venu G
Pucci, Michael J
Sutcliffe, Robert P
Tingstedt, Bobby
van der Kolk, Marion
Vrochides, Dionisios
Armstrong, Misha
Wei, Alice
Williamsson, Caroline
Yeo, Charles J
Zani, Sabino
Zouros, Efstratios
Rozzini, Renzo
Abu Hilal, Mohammed
Publication date
2024-01-29
Metadata
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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. Keywords: aged; enhanced recovery after surgery; meta-analysis; pancreatoduodenectomy; perioperative care.Citation
Kuemmerli C, Balzano G, Bouwense SA, Braga M, Coolsen M, Daniel SK, Dervenis C, Falconi M, Hwang DW, Kagedan DJ, Kim SC, Lavu H, Nussbaum D, Partelli S, Passeri MJ, Pecorelli N, Pillarisetty VG, Pucci MJ, Sutcliffe RP, Tingstedt B, van der Kolk M, Vrochides D, Armstrong M, Wei A, Williamsson C, Yeo CJ, Zani S, Zouros E, Rozzini R, Abu Hilal M. Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis. J Hepatobiliary Pancreat Sci. 2024 May;31(5):308-317. doi: 10.1002/jhbp.1417. Epub 2024 Jan 29.Type
ArticlePMID
38282543Publisher
Wileyae974a485f413a2113503eed53cd6c53
10.1002/jhbp.1417