Effects of the Enhanced Recovery Program on the Recovery and Stress Response in Patients With Cancer Undergoing Pancreatoduodenectomy
| Autor: | Dimitrios P. Korkolis, Maria Kapritsou, Ioannis Kaklamanos, Margarita Giannakopoulou, Elizabeth Papathanassoglou, Meropi Mpouzika, Evangelos Konstantinou |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Hydrocortisone Emotions Stomach emptying Medical and Health Sciences Pancreaticoduodenectomy law.invention 03 medical and health sciences 0302 clinical medicine Adrenocorticotropic Hormone Randomized controlled trial law Pancreaticojejunostomy Numeric Rating Scale Humans Medicine Prospective Studies 030212 general & internal medicine Prospective cohort study Pancreas fistula Aged Advanced and Specialized Nursing Pain Postoperative business.industry Confounding Age Factors Gastroenterology Repeated measures design Middle Aged Pancreatic Neoplasms Anesthesia Biomarker (medicine) Female 030211 gastroenterology & hepatology Clinical Medicine Fast track Enhanced Recovery After Surgery business Stress Psychological Hormone |
| Zdroj: | Gastroenterology Nursing. 43:146-155 |
| ISSN: | 1042-895X |
| DOI: | 10.1097/sga.0000000000000417 |
| Popis: | Aim the study was the comparison of enhanced recovery after surgery (ERAS) versus conventional care (CON) protocols in patients undergoing pancreatoduodenectomy with regard to pain intensity, emotional response (optimism/sadness/stress), and stress biomarker levels (adrenocorticotropopic hormone, cortisol). We conducted a prospective two-group randomized controlled study with repeated measures in 85 patients with cancer pancreatoduodenectomy. In the ERAS group (N = 44), the ERAS protocol was followed, compared with the CON group (N = 41). We assessed pain with the numeric rating scale and a behavioral scale (Critical Care Pain Observation Tool), emotional responses (numeric rating scale), and serum adrenocorticotropopic hormone and cortisol levels at three time points: T1, admission day; T2, day of surgery; and T3, discharge day (ERAS) or the fifth day of stay (CON). Data were analyzed by linear mixed modeling to account for repeated measurements. We observed decreased postoperative pain in ERAS patients after adjusting for confounders (p = .002) and a trend for less complications. No significant associations with stress/emotional responses were noted. Only age, but not protocol, appeared to have a significant effect on adrenocorticotropopic hormone levels despite a significant interaction with time toward increased adrenocorticotropopic hormone levels in the ERAS group. In conclusion, despite its fast track nature, ERAS is not associated with increased stress in patients undergoing pancreatoduodenectomy and is associated with decreased pain. |
| Databáze: | OpenAIRE |
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