NOVEL PREOPERATIVE PATIENT-CENTERED SURGICAL WELLNESS PROGRAM IMPACTS LENGTH OF STAY FOLLOWING PANCREATECTOMY
Danielle K. DePeralta*, Mazhar Soufi, katelyn flick, Rachel E. Simpson, Cameron Colgate, Josh Sadowski, Eugene P. Ceppa, Michael G. House, Nicholas J. Zyromski, Attila Nakeeb, William Wooden, E M. Kilbane, Nancy Strange, Kristen Kelley, C. Max Schmidt
Surgery, Indiana University, Boston, MA
Background
Pancreatic resections have the potential for significant morbidity and mortality. Enhanced Recovery After Surgery (ERAS) protocols, while appealing, have been slowly adopted by pancreatic surgeons. An urban, academic medical center created a simple, preoperative, patient-centered, surgical wellness bundle (PWB). This study assessed the impact of this preoperative wellness bundle on patient outcomes following pancreatectomy.
Methods
All pancreatoduodenectomies (PD) and distal pancreatectomies (DP) performed at a single academic medical center from 6/2015-6/2018 were included on study. The PWB consisted of chlorhexidine bath solution, topical mupirocin for the nostrils, an incentive spirometer, immunonutrition supplements, and smoking cessation information, all contained in a sporty red roller bag. In select cases, study staff performed structured patient interviews, observations, and standardized surveys at key intervals throughout the perioperative period. Clinical parameters were obtained from a retrospective review of a prospective clinical database and augmented by institutional ACS NSQIP data, Vizient data and medical records. Chi-Square/Fisher's Exact and Independent-Samples t-Tests were used for univariable analyses; multivariable regression (MVR) was performed.
Results
A total of 669 pancreatectomy patients (411 PD, 258 DP) were enrolled. Of these, 361 patients received the PWB (223 PD, 138 DP). Compliance with individual elements exceeded 60%. Patients that did and did not receive the PWB were similar with respect to age, sex, functional status, presence of comorbidities, and indication for/ extent of surgery. On univariable analysis, patients who received the PWB had a shorter length of stay (8.5 vs. 10.2 days; p=0.04). A trend existed for less acute renal failure (0.6 vs. 1.9%; p=0.185) and delayed gastric emptying (12.3% vs. 16.7%; p=0.118). On multivariable analysis, patients who received the PWB had a shorter length of stay (OR 0.81, CI 0.72-0.91; p<0.001).
Conclusions
In an era of slow adoption of ERAS among pancreatic surgeons, implementation of a simple, preoperative, patient-centered, surgical wellness bundle results in a significant reduction in length of stay and may be associated with improved perioperative outcomes.
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