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Enhanced Recovery After Surgery Pathway in Patients Undergoing Pancreaticoduodenectomy

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Abstract

Background

Enhanced recovery after surgery (ERAS®) pathways have reduced morbidity and length of hospital stay (LOS) in orthopedics, bariatric, and colorectal surgery. New perioperative care protocols have been tested in patients undergoing pancreaticoduodenectomy (PD), with controversial results on morbidity. Incomplete data about ERAS items compliance have been reported. The aim of this study was to assess compliance with an ERAS protocol and its impact on short-term outcome in patients undergoing PD.

Methods

A comprehensive ERAS protocol was applied in 115 consecutive patients undergoing PD. Each ERAS patient was matched with one patient who received standard perioperative care. Match criteria were age, gender, malignant/benign disease, and PD-specific prognostic score.

Results

No adverse effect related to ERAS items occurred. Compliance with postoperative items ranged between 38 and 66 %. The ERAS group had an earlier recovery of mobilization (p < 0.001), oral feeding (p < 0.001), gut motility (p < 0.001), and an earlier suspension of intravenous fluids (p = 0.041). No difference between ERAS and control group was found in mortality, overall morbidity, and major complication rates. Subgroup analysis showed that 43/60 (71 %) patients with early postoperative low compliance with the ERAS pathway had complications. The ERAS pathway significantly shortened LOS in uneventful patients or those with minor complications (11.2 vs. 13.7 days, p = 0.001).

Conclusion

The ERAS pathway was feasible and safe, yielding an earlier postoperative recovery. An ERAS protocol should be implemented in patients undergoing PD; however, patients with early postoperative low compliance should be carefully managed.

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Authors and Affiliations

  1. Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Marco Braga, Nicolò Pecorelli, Riccardo Ariotti, Giovanni Capretti, Gianpaolo Balzano & Renato Castoldi

  2. Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Milan, Italy

    Massimiliano Greco & Luigi Beretta

Authors
  1. Marco Braga
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  2. Nicolò Pecorelli
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  3. Riccardo Ariotti
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  4. Giovanni Capretti
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  5. Massimiliano Greco
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  6. Gianpaolo Balzano
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  7. Renato Castoldi
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  8. Luigi Beretta
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Correspondence to Marco Braga.

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Braga, M., Pecorelli, N., Ariotti, R. et al. Enhanced Recovery After Surgery Pathway in Patients Undergoing Pancreaticoduodenectomy. World J Surg 38, 2960–2966 (2014). https://doi.org/10.1007/s00268-014-2653-5

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  • DOI: https://doi.org/10.1007/s00268-014-2653-5

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