The Analysis Of Safety And Efficacy Of Eras In Pancreatic Surgery

Objective:Based on Propensity Score Matched Analysis,to investigate the safety and efficacy of enhanced recovery after surgery(ERAS)in pancreatic surgery,and then provide references for the application of ERAS in pancreatic surgery.Methods:By using the method of retrospective cohort study,collected the clinical data of ninety-five patients who had pancreatic surgery in the First Affiliated Hospital of University of South China from January 2014 to November 2018.Among them,54 patients who underwent pancreatic surgery from August 2016 to November 2018 used the ERAS treatment during the operation,setting it as the ERAS group(experimental group).And 41 patients who underwent pancreatic surgery from January 2014 to July 2016 used the traditional treatment during the operation,setting it as the traditional group(the control group).The baseline characteristics including the basic information of the patients,disease diagnosis,surgical procedure and time of operation were used to match the cases to 1:1 by Propensity Score Matched Analysis,and the clinical effects of the two groups were compared.Observation indicators:(1)postoperative laboratory examination indicators:the value of white blood cells(WBC),hemoglobin(HGB),albumin(ALB),total bilirubin(TBIL),direct bilirubin(DBIL)on the 1st,the 3rd,the 5th and the 7th day among the POD.(2)Postoperative clinical indicators:the first leaving bed time,the first feeding time,the first anal defecation time,gastric tube removal time(simple gastrointestinal decompression and input loop decompression),the catheter removal time,abdominal drainage tube removal time,postoperative hospital stay,postoperative hospitalization expenses.(3)Postoperative complications:morbidity of moderate to severe pain,pancreatic fistula,bile leakage,hemorrhage,reoperation rate,mortality,and complication rate.Results:The baseline data of the two groups of patients were well balanced after using Propensity Score Matched Analysis,and 37 patients in each group after matching.(1)Laboratory examination indicators:there was no significant difference between two groups(P>0.05)about the white blood cells,hemoglobin,albumin,total bilirubin,direct bilirubin before the surgery;there was no significant difference between two groups(P>0.05)about the white blood cells,hemoglobin,total bilirubin,direct bilirubin In terms of in the 1st,3rd,5th,7th days after surgery.The postoperative albumin value in the ERAS group was higher than that in the traditional group(P<0.05).(2)Postoperative clinical indicators:the first leaving bed time,the first feeding time,the first anal defecation time,the catheter removal time,the postoperative hospital stays and the postoperative hospitalization expenses in the ERAS group were(2.69±2.05)d,(5.86±3.88)d,(4.32±2.12)d,(3.03±1.56)d,(19.38±11.72)d,(4.06±2.09)ten thousand yuan,and the above indicators in the control group were(3.82±2.22)d,(8.16±5.28)d,(5.35±2.09)d,(4.08±2.30)d,(25.43±12.35)d,(5.13±2.12)ten thousand yuan,there was significant differences between the two groups(t=2.209,2.131,2.056,2.308,2.163,2.185,P<0.05).(3)Postoperative complications:the incidence rate of moderate to severe pain in the ERAS group was less than that in the conventional group(P<0.05).There was no significant difference in the total incidence rate of postoperative complications between the two groups(P>0.05).The incidence rate of grade B and C pancreatic fistula in ERAS group respectively were 10.8%(4/37)and 2.7%(1/37),and the above indicators in the control group respectively were 16.2%(6/37)and5.4%(2/37),there was no significant difference in the incidence rate of pancreatic fistula between the two groups(χ~2=0.840,P>0.05).There was no significant difference between the two groups in bile leakage(P>0.05).The incidence rate of Pancreatic fistula erodes blood vessels bleeding,anastomotic bleeding,and upper gastrointestinal bleeding in the ERAS group respectively were 0%(0/37),5.4%(2/37)and 2.7%(1/37),and the above indicators in the control group respectively were 2.7%(1/37),5.4%(2/37)and 2.7%(1/37),there was no significant difference between two groups(χ~2=0.158,P>0.05).In both the ERAS group and the traditional group,one patient died of serious complications after the surgery and one patient underwent secondary surgery for postoperative bleeding.Conclusion:ERAS is safe and effective in perioperative period of pancreatic surgery,it can accelerate recovery of postoperative body function,shorten postoperative hospital stays,pay less in postoperative hospitalization and improve the comfort and satisfaction of the inpatients.So it is worthy of clinical application.