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Background: There is increasing interest in implementing comprehensive perioperative protocols, including preoperative optimization and education, perioperative goal-directed fluid management, and postoperative fast tracking, to enhance recovery after surgery. Data on the outcomes of these protocols in pancreatic surgery, however, are limited.
Study Design: A retrospective review of a prospectively maintained pancreas surgery database at a single institution from August 2012 to April 2015 was undertaken. An enhanced recovery protocol was initiated in October 2014, and patients were divided into groups according to preprotocol or postprotocol implementation. Preoperative, intraoperative, and postoperative data were tabulated. Statistical analysis was performed with Student's t-test and Fisher's exact tests, as well as equality of variances where appropriate, using SAS System software (SAS Institute).
Results: Three hundred and seventy-eight patients (181 men, mean age 54 years, BMI 28 kg/m(2)) underwent elective pancreatic surgery during the study period, 297 patients preprotocol and 81 postprotocol. There were no significant differences in preoperative or intraoperative characteristics. Mean postoperative length of stay was significantly lower in the Enhanced Recovery After Surgery group (7.4 vs 9.2 days; p < 0.0001). Hospital costs were similarly lower in the Enhanced Recovery After Surgery group ($23,307.90 vs $27,387.80; p < 0.0001). Readmission (29% vs 32%) and pancreatic fistula (26% vs 28%) rates were similar between groups. Delayed gastric emptying was lower in the Enhanced Recovery After Surgery group (26% vs 13%; p = 0.03).
Conclusions: Implementation of an enhanced recovery after pancreatic surgery protocol significantly decreased length of stay and hospital cost without increasing readmission or morbidity. Despite patient complexity and the potential need for individualization of care, enhanced recovery protocols can be valuable and effective in high-risk patient populations, including pancreatic surgery patients.
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http://dx.doi.org/10.1016/j.jamcollsurg.2015.12.036 | DOI Listing |
J Int Soc Sports Nutr
December 2025
The Center for Applied Health Sciences, Canfield, OH, USA.
Creatine monohydrate supplementation (CrM) is a safe and effective intervention for improving certain aspects of sport, exercise performance, and health across the lifespan. Despite its evidence-based pedigree, several questions and misconceptions about CrM remain. To initially address some of these concerns, our group published a narrative review in 2021 discussing the scientific evidence as to whether CrM leads to water retention and fat accumulation, is a steroid, causes hair loss, dehydration or muscle cramping, adversely affects renal and liver function, and if CrM is safe and/or effective for children, adolescents, biological females, and older adults.
View Article and Find Full Text PDFEClinicalMedicine
September 2024
Department of Medicine, University of Cambridge, Cambridge, UK.
Background: Even patients with normal computed tomography (CT) head imaging may experience persistent symptoms for months to years after mild traumatic brain injury (mTBI). There is currently no good way to predict recovery and triage patients who may benefit from early follow-up and targeted intervention. We aimed to assess if existing prognostic models can be improved by serum biomarkers or diffusion tensor imaging metrics (DTI) from MRI, and if serum biomarkers can identify patients for DTI.
View Article and Find Full Text PDFFront Med (Lausanne)
December 2024
Section of Neurobiology of the Eye, Ophthalmic Research Institute, University of Tübingen, Tübingen, Germany.
Purpose: Changes in choroidal thickness (ChT) are proposed to predict myopia development but evidence is mixed. We investigated time courses of choroidal responses, following different types of dynamic artificial stimulation in chicks with and without spectacle lenses, as well as changes in retinal dopamine metabolism and expression of candidate genes.
Methods: Chicks were kept in an arena surrounded by computer monitors presenting dynamic checkerboard fields of small, medium and large size.
Cureus
November 2024
Diagnostic Radiology, University of Arkansas for Medical Sciences, Little Rock, USA.
Background: Accurate diagnosis and understanding of brain disorders are crucial for the best treatment. While multimodal neuroimaging is essential, it has its limitations. Conventional computed tomography (CT) and magnetic resonance imaging (MRI) provide detailed anatomical information but lack molecular insights, while 18F-fluorodeoxyglucose-positron emission tomography (FDG PET) offers metabolic data but often has limited spatial resolution.
View Article and Find Full Text PDFBiomed Res Int
December 2024
Department of Occupational Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
The integration of artificial intelligence (AI) technologies into physical and mental rehabilitation has the potential to significantly transform these fields. AI innovations, including machine learning algorithms, natural language processing, and computer vision, offer occupational therapists advanced tools to improve care quality. These technologies facilitate more precise assessments, the development of tailored intervention plans, more efficient treatment delivery, and enhanced outcome evaluation.
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