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Risk factors for failure of early recovery from pancreatoduodenectomy despite the use of enhanced recovery after surgery protocols and a physical aging score to predict postoperative risks
Author(s) -
Kobayashi Shinjiro,
Segami Kohei,
Hoshino Hiroyuki,
Nakahara Kazunari,
Katayama Masafumi,
Koizumi Satoshi,
Otsubo Takehito
Publication year - 2018
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.540
Subject(s) - medicine , confidence interval , odds ratio , american society of anesthesiologists , framingham risk score , surgery , disease
Background Enhanced recovery after surgery ( ERAS ) protocols are beneficial for pancreatoduodenectomy ( PD ). Our aim was to evaluate risk factors associated with ERAS protocol failure after PD . Methods Clinical variables of 187 patients managed using ERAS protocols between April 2011 and April 2017, including non‐early recovery (non‐ ER ) patients, with complications or requiring a hospital stay ≥15 days, and early recovery ( ER ) patients, were compared. A physical aging ( PA ) score was devised to predict postoperative risks. Results Independent risk factors of complications were a pre‐albumin level ≤18 mg/dl (odds ratio ( OR ) 2.197; 95% confidence interval ( CI ) 1.052–4.622), and an American Society of Anesthesiologists ( ASA ) score ≥ II ( OR 2.195; 95% CI 1.052–4.746). Independent risk factors for hospital stay ≥15 days ( P < 0.001) were age ≥70 years ( OR 2.438; 95% CI 1.122–5.299) and an ASA score ≥ II ( OR 2.348; 95% CI 1.109–4.968). The PA score included age, ASA score, and pre‐albumin level. The complication rate for each PA score was as follows: score “0”, 12.1%; score “1”, 18.2%; score “2”, 26.9%; score “3”, 30.8%; and score “≥4”, 47.2%. Conclusions Advanced age, poor nutrition, and serious illnesses can cause ERAS protocol failure. The PA score is effective for predicting postoperative progress.