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THE DIFFERENCES IN THE RECOVERY PROGRESS AFTER PANCREATICODUODENECTOMY IN ELDERLY AND NON ELDERLY PATIENTS FOLLOWING ENHANCED RECOVERY PROGRAMMES
Qiuju Tian*1, Mingxia Chen1, Xiaoping Fang2, Xueyang Li1
1Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; 2Pancreatic Center,, the first Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
Obejective
The aims of this study were to analysis the effect of enhanced recovery on elderly patients after pancreaticoduodenectomy (PD) and compare the differences in recovery progress between elderly and non-elderly patients.
Methods
Consecutive non-diabetes patients undergoing PD were studied in pancreatic center in a single institution between January 2015 and February 2016. Ninety-eight patients matched inclusion and exclusion standard were divided into group A (< 60 years old) and group B(≥ 60 years old) accroding to age, and both of the two groups were managed according to enhanced recovery programmes. Fasting blood glucose (FBG) in postoperative day (POD) 1, 3 and 7, the first postoperative ambulatory episode, recovery of gastrointestinal function, including the time of exsufflation through anus and defecation, whether using glycerine enema or not, complication, postoperative length of stay (LOS) and LOS were measured. The measurement data were showed in the form of average value standard error and analyzed using independent sample t test. The categorical data were analyzed using Chi-square test.
Results
The study included 98 patients, including 49 elderly patients in group A and 49 non-elderly patients in group B. The mean age was 48.84 1.45 in group A and 68.78 0.86 in group B. There were no differences in the demographics and other baseline information between the two groups. Complications after PD did not differ between groups (χ2 = 2.841, p = 0.092).Both postoperative length of stay(LOS) and LOS did not differ between groups (t = - 0.741, p = 0.162; t=- 0.745, p = 0.158) .The first postoperative ambulatory episode did not differ between the two goups (t = - 1.361, p = 0.177). Recovery of gastrointestinal function, including the time of exsufflation through anus and defecation did not differ between the two groups (t = - 0.870, p = 0.387; t = - 0.463, p = 0.646;). Whether using glycerine enema to induce the exsufflation and defecation did not differ in groups (χ2 =1.027, p = 0.311). There were difference in FBG in POD1,3 and 7 in group B and in group A (t = - 4.074 , - 2.151, - 2.376 ; p=0.000, 0.034, 0.019).
Conclusions
The outcomes of the effect of enhanced recovery programmes on elderly and non-elderly patients after PD are without difference. However, elderly patients were usually along with higher stress compared with non elderly patients in the recovery progress after PD following enhanced recovery programmes. We need to pay more attention to elderly patients to enhance physical reserve and ruduce the level of stress hyperglycemia. What’s more , we are going to follow those patients to explore whether the higher stress has effects on the long term of prognosis.
Keywords
Pancreaticoduodenectomy; enhaced revovery ;elderly patients; stress hyperglycemia
The comparison of fasting blood glucose(FBG) in POD 1, 3 and 7 between the two groups(mmol/L)
| groups | N | FBG in POD1 | FBG in POD3 | FBG in POD7 | | A | 49 | 9.23 0.45 | 6.67 0.13 | 6.49 0.15 | | B | 49 | 11.96 0.49 | 7.18 0.19 | 7.07 0.19 | | t&χ2 | | －4.074 | －2.151 | －2.376 | | p | | 0.000 | 0.034 | 0.019 |
there is statistical significance when P < 0.05
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