Application of perioperative care based on a quantitative evaluation strategy in pancreatic cancer patients undergoing pancreaticoduodenectomy

Abstract

BACKGROUND

Pancreaticoduodenectomy (PD) is a complex procedure associated with substantial perioperative morbidity. Standardized perioperative pathways may improve coordination among surgical, anesthesia, and nursing teams, but the value of assigning care intensity according to a locally developed quantitative assessment remains uncertain. This study examined the short-term outcomes associated with a quantitative risk-stratified perioperative care pathway in patients undergoing PD.

AIM

To examine whether a quantitative risk-stratified perioperative care pathway was associated with short-term recovery, postoperative complications, perioperative hemodynamic measurements, and psychological scores after PD.

METHODS

This retrospective cohort study included 260 adults who underwent elective PD between January 2020 and December 2023. According to the perioperative care protocol recorded in their medical records, 130 patients received a quantitative risk-stratified care pathway and 130 received routine perioperative care. The primary outcomes were intraoperative blood loss, time to first postoperative flatus, postoperative length of stay, and the occurrence of any recorded postoperative complication. Secondary outcomes included mean arterial pressure (MAP), heart rate (HR), and Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores.

RESULTS

Intraoperative blood loss was lower in the pathway group than in the routine-care group (346.09 ± 65.37 mL vs 390.15 ± 70.12 mL; mean difference: -44.06 mL; 95%CI: -60.62 to -27.50 mL; P < 0.001). Time to first postoperative flatus (42.57 ± 8.04 hours vs 50.16 ± 7.52 hours; P < 0.001) and postoperative length of stay (10.85 ± 2.19 days vs 12.03 ± 2.45 days; P < 0.001) were also shorter in the pathway group. At least one recorded postoperative complication occurred in 14 of 130 patients (10.77%) in the pathway group and 32 of 130 patients (24.62%) in the routine-care group (risk ratio = 0.44; 95%CI: 0.25-0.78; P = 0.003). MAP did not differ significantly between the groups at T1 but was higher in the pathway group at T2 and T3 (both P < 0.001). HR did not differ significantly between the groups at T1, T2, or T3 after Bonferroni correction. At postoperative week 1, SAS and SDS scores were lower in the pathway group than in the routine-care group (both P < 0.001).

CONCLUSION

The quantitative risk-stratified perioperative care pathway was associated with less intraoperative blood loss, earlier postoperative gastrointestinal recovery, a shorter hospital stays, fewer recorded complications, and lower postoperative anxiety and depression scores. Because this was a single-center retrospective study, these associations should not be interpreted as evidence of causality.

Keywords: Quantitative evaluation strategy; Perioperative care; Pancreatic cancer; Pancreaticoduodenectomy; Application effect

Core Tip: This retrospective cohort study examined a locally developed quantitative risk-stratified perioperative care pathway in 260 patients undergoing pancreaticoduodenectomy. Compared with routine care, use of the pathway was associated with less intraoperative blood loss, earlier first flatus, a shorter postoperative hospital stays, fewer recorded complications, and lower anxiety and depression scores at postoperative week 1. These findings support further prospective evaluation of the pathway but do not establish an independent causal effect.