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2012 | 84 | 8 | 390-398
Article title

Impact of Fast-Track Concept Elements in the Classical Pancreatic Head Resection (Kausch-Whipple Procedure)

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Languages of publication
EN
Abstracts
EN
The aim of the study was to determine statistically significant factors with an impact on the early postoperative surgical outcome.Material and methods. The influence of applied fast-track components on surgical results and early postoperative outcome in 143 consecutive Kausch-Whipple procedure patients was evaluated in a single-center retrospective analysis of a prospective collection of patient-associated pre-, peri- and postoperative data from 1997-2006.Results. The in-hospital mortality rate was 2.8% (n=4). Fast-track measures were shown to have no effect on the morbidity rate in the multi-variate analysis. Over the study period, a decrease of intraoperative infusion volume from 14.2 mL/kg body weight/h in the first year to 10.7 mL/kg body weight/h in the last year was accompanied by an increase in patients requiring intraoperative catecholamines, up from 17% to 95%. The administration of ropivacain/sufentanil via thoracic peri-dural catheter injection initiated in 2000 and now considered the leading analgesic method, was used in 95% of the cases in 2006. Early extubation rate rose from 16.6% to 57.9%.Conclusions. Fast-track aspects in the perioperative management have become more important in several surgical procedure even in those with a greater invasiveness such as Kausch-Whipple. However, such techniques used in peri-operative management of Kausch-Whipple pancreatic-head resections had no impact on the morbidity rate. In addition, the low in-hospital mortality rate was particularly attributed to surgical competence.
Publisher

Year
Volume
84
Issue
8
Pages
390-398
Physical description
Dates
published
1 - 8 - 2012
online
17 - 9 - 2012
Contributors
  • Institute for Quality Assurance in Medicine, Magdeburg, University Hospital
author
  • Department of General, Abdominal and Vascular Surgery, University Hospital in Magdeburg
  • Department of Anesthesiology, Intensive Care and Palliative Medicine, Carl-Thiem Hospital in Cottbus
author
  • Stat Consult, Magdeburg
author
  • Department of Surgery, Carl-Thiem Hospital Cottbus, Cottbus
author
  • Department of General, Abdominal and Vascular Surgery, University Hospital in Magdeburg
References
  • Schenk W: Fast-track-Rehabilitation in der Viszeralchirurgie. Der Chirurg 2009; 690-701.
  • Kehlet H: Fast-track colorectal surgery. Lancet 2008; 371: 791-93.[WoS]
  • Kehlet H, Wilmore Dw: Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 2008; 248: 189-98.
  • Berberat Po, Ingold H, Gulbinas A et al.: Fast track-different implications in pancreatic surgery. J Gastrointest Surg 2007; 11: 880-87.
  • Lindenblatt N, Park S, Alsfasser G et al.: Intraoperative fluid management in pancreatic resections - the surgeon's view. Zentralbl Chir 2008; 133: 168-75.
  • Kehlet H: Principles of fast track surgery. Multimodal perioperative therapy programme. Der Chirurg 2009; 80: 687-89.
  • Brandstrup B, Tonnesen H, Beier-Holgersen R et al.: Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003; 238: 641-48
  • Joshi GP: Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg 2005; 101: 601-05.
  • Lobo Dn, Bostock Ka, Neal Kr et al.: Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 2002; 359: 1812-18.
  • Nisanevich V, Felsenstein I, Almogy G et al.: Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005; 103: 25-32.
  • Holte K, Kehlet H: Compensatory fluid administration for preoperative dehydration - does it improve outcome? Acta Anaesthesiol Scand 2002; 46: 1089-93.
  • Holte K, Sharrock Ne, Kehlet H: Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 2002; 89: 622-32.
  • Kox J, Spies C: Check-up Anästhesiologie. Springer Medizin Verlag, Heidelberg 2005.
  • Gan TJ, Soppitt A, Maroof M et al.: Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002; 97: 820-26.
  • Holte K, Kehlet H: Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg 2006; 202: 971-89.
  • Lang K, Boldt J, Suttner S et al.: Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg 2001; 93: 405-09, 403rd contents page.
  • Luther B: Nichtokklusive mesenteriale Ischämie - Diagnostik und Therapie aus gefäßchirurgischer Sicht. Chir Gastroenterol 2006; 29-35.
  • Bundesärztekammer, Paul-Ehrlich-Institut (2005): Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Hämotherapie) gemäß §§ 12 und 18 des Transfusionsgesetzes (Novelle 2005). In: (Hrsg.).
  • Hébert Pc, Fergusson D, Blajchman Ma et al.: Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions. JAMA 2003; 289: 1941-49.
  • White Pf, Kehlet H, Neal Jm et al.: The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg 2007; 104: 1380-96, table of contents.[WoS]
  • Block Bm, Liu Ss, Rowlingson AJ et al.: Efficacy of postoperative epidural analgesia: a meta-analysis. Jama 2003; 290: 2455-63.
  • Kehlet H, Wilmore DW: Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183: 630-41.
  • Bisgaard T, Kehlet H: Early oral feeding after elective abdominal surgery-what are the issues? Nutrition 2002; 18: 944-48.
  • Schricker T, Wykes L, Eberhart L et al.: The anabolic effect of epidural blockade requires energy and substrate supply. Anesthesiology 2002; 97: 943-51.
  • Horstmann O, Markus Pm, Ghadimi Mb et al.: Pylorus preservation has no impact on delayed gastric emptying after pancreatic head resection. Pancreas 2004; 28: 69-74
  • Zgodzinski W, Dekoj T, Espat NJ: Understanding clinical issues in postoperative nutrition after pancreaticoduodenectomy. Nutr Clin Pract 2005; 220: 654-61.
  • Holte K, Kehlet H: Postoperative ileus: a preventable event. Br J Surg 2000; 87: 1480-93
  • Kehlet H, Dahl JB: Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003; 362: 1921-28.
  • Rigg Jr, Jamrozik K, Myles Ps et al.: Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002; 359: 1276-82.
  • Rodgers A, Walker N, Schug S et al.: Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ (Clinical research ed) 2000; 321: 1493.
Document Type
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-012-0066-4
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