Réhabilitation améliorée pour la chirurgie hépato-pancréatico- biliaire

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Ressource 1Download: Mémoire no 3235 Mme Jarrar.pdf (678.85 [Ko])
State: Public
Version: After imprimatur
Serval ID
serval:BIB_D35535E6FB33
Type
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Collection
Publications
Institution
Title
Réhabilitation améliorée pour la chirurgie hépato-pancréatico- biliaire
Author(s)
JARRAR G.
Director(s)
HÜBNER M.
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2016
Language
english
Number of pages
11
Abstract
Background Enhanced recovery after surgery (ERAS) reduces complications and hospital stay in colorectal sur- gery. Thereafter, ERAS principles were extended to liver surgery. Previous implementation of an ERAS program in colorectal surgery may influence patients undergoing liver surgery in a non-ERAS setting, on the same ward. This study aimed to test this hypothesis.
Methods Retrospective analysis based on prospective data of the adherence to the institutional ERAS-liver protocol (compliance) in three cohorts of consecutive patients undergoing elective liver surgery, between June 2010 and July 2014: before any ERAS implementation (pre-ERAS n = 50), after implementation of ERAS in colorectal (inter- mediate n = 50), and after implementation of ERAS in liver surgery (ERAS-liver n = 74). Outcomes were func- tional recovery, postoperative complications, hospital stay, and readmissions.
Results The three groups were comparable for demographics; laparoscopy was more frequent in ERAS-liver (p = 0.009). Compliance with the enhanced recovery protocol increased along the three periods (pre-ERAS, inter- mediate, and ERAS-liver), regardless of the perioperative phase (pre-, intra-, or postoperative). ERAS-liver group displayed the highest overall compliance rate with 73.8 %, compared to 39.9 and 57.4 % for pre-ERAS and inter- mediate groups (p = 0.072/0.056). Overall complications were unchanged (p = 0.185), whereas intermediate and ERAS-liver groups showed decreased major complications (p = 0.034). Consistently, hospital stay was reduced by 2 days (p = 0.005) without increased readmissions (p = 0.158).
Conclusions The previous implementation of an ERAS protocol in colorectal surgery may induce a positive impact on patients undergoing non-ERAS-liver surgery on the same ward. These results suggest that ERAS is safely applicable in liver surgery and associated with benefits.
Keywords
enhanced recovery after surgery, liver surgery, compliance
Create date
05/09/2017 12:35
Last modification date
20/08/2019 15:53
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