| During the last two decades,enhanced recovery after surgery(ERAS)has shown documented efficacy in elective surgery.It has increasingly replaced conventional procedures in surgical care.However,Few centers have successfully adopted ERAS approach for laparoscopic pancreatoduodenectomy(LPD).We describe the implementation and efficacy of an ERAS program for LDP in a tertiary teaching center in Tongji Hospital,Wuhan.Firstly,we set up a cooperative group and design ERAS checklists.Then,we develop suitable ERAS strategies for LPD.Part 1.Setup a multi-disciplinary team and develop an ERAS checklist Objective:To improve the quality and safety of nursing in laparoscopic pancreatic,we develop an ERAS checklist.Methods : A new ERAS checklist was designed and applied for laparoscopic pancreatic patients.Totally 118 patients at our sin gle hospital was under went t-he ERAS program from June 2015 to June 2016.Several designed points,include len gth of urinary catheterization,time to first solid meal,were observed.Results:During the program,we got 97 effective checklists from totally 118.During the application of the checklist,improvements were observed in several points.The application of ventilator muscle training was observed from 46% to 100%,preoperational water-food-deprivation from 32% to 96%,canals ventriculi removal postoperational from 46% to 96%,the next day after oral administration of waterfrom 54% to 100%,indoor activities from the third day after surgery from 32% to92%.Conclusion:Our designed checklist can be performed safely and can help improve th e quality of nursing in patients with pancreatic disease who undergoing laparoscopic s urgery.Therefore,it could be a good option to perform for this kind of patients with h igh risk for developing postoperative pancreatic.Part 2.Evaluate the benefits of ERAS for LPD patients Objective: To evaluate the benefits of the Enhanced Recovery After Surgery(ERAS)program compared to conventional care in patients undergoing Laparoscopic pancreaticoduodenectomy(LPD).Methods: July 2014-June 2015 were compared to a retrospective cohort of patients undergoing LPD managed in a traditional perioperative care environment(control:July 2015-June 2016)at our hospital.97 patients who participated in the ERAS program were compared to 76 previous patients who underwent traditional nursing program.Results:The ERAS Program for LPD decreased both hospital expenses and hospital length of stay without compromising readmission rates.Quality of life was also better in the ERAS group.However,no significant differences were noted in postoperative complications,mortality and readmission rates(P<0.01).Conclusion:ERAS in LPD has been shown to be safe and effective in improving recovery through shorter hospital stay and accelerate recovery without increasing postoperative complication rates. |
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