Analysis of enhanced recovery protocol failure for pancreatic surgery

Author:

Drozdov Evgenij SergeevichORCID,Korotkevich Aleksej Grigor'evichORCID,Klokov Sergej SergeevichORCID,Grishchenko Maksim YUr'evichORCID

Abstract

Introduction. Enhanced recovery protocols (ERP) after surgery are evidence-based perioperative management programs aimed at reducing the response to surgical stress and accelerating recovery. These protocols have shown their effectiveness in various surgical sections, including surgical pancreatology. However, in some patients who have undergone pancreatic surgery, these protocols are not effective. The aim of the study was to analyse risk factors for ERP failure during pancreatic surgery, and to develop a predictive model for assessing the risk of ERP failure. Material and methods. A retrospective - prospective two-center study included 122 patients who underwent surgical interventions on the pancreas. ERP was considered unsuccessful if one or more of the following signs were found in a patient: the duration of postoperative hospitalization exceeding 14 days, in-hospital or 30-day mortality, readmission within 30 days. Patients included in the study were divided into two groups: 1) patients who did not have signs of ERP failure - the enhanced recovery group (ER), 2) patients who had signs of ERP failure (non-ER group). The authors evaluated clinical factors that might be associated with the risk of ERP failure. Results. The non-ER group included 46 patients. Univariate and multivariate logistic analysis allowed specifying independent risk factors for ERP failure: age over 70 years (p=0.01), presence of sarcopenia (odds ratio (OR) 4.75, 95% confidence interval (95% CI) 1.7 - 11.9, p=0.01), ASA III score (OR 1.8, 95% CI 1.1 - 2.6, p=0.04), density of the pancreas parenchyma (OR 5.9, 95 % CI 1.8 15.4, p0.01). To develop a score for the risk of ERP failure, each feature was empirically assigned points from 1 to 3 taking into account its severity (the odds ratio value). With a score of 4, the risk of ERP failure was assessed as high, with a score 4, the risk of ERP failure was assessed as low. The sensitivity, specificity and overall accuracy of the developed model were 84.8%, 82.9% and 83.6%, respectively. Conclusions. Based on the study results, the authors developed a scoring prognostic model to evaluate the risk of ERP failure in patients exposed to pancreatic surgery. This model can be used to stratify patients according to their risk of ERP failure (high or low

Publisher

VSMU N.N. Burdenko

Subject

General Earth and Planetary Sciences,General Environmental Science

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3