Reducing postoperative complications and improving clinical outcome:enhanced recovery after surgery in pancreaticoduodenectomy.

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Reducing postoperative complications and improving clinical outcome:enhanced recovery after surgery in pancreaticoduodenectomy.

Int J Surg. 2017 Jan 26;:

Authors: Dai J, Jiang Y, Fu D

Abstract
BACKGROUND: An enhanced recovery after surgery (ERAS) programme aims to reduce the stress response to surgery and thereby accelerate recovery. The experience of implementing ERAS programmes in pancreatoduodenectomy (PD) is relatively limited. The aim of this study was to evaluate the feasibility, safety and clinical outcomes of ERAS programme after PD at a high-volume Chinese university referral centre.
METHODS: Between September 2014 and July 2016, a retrospective analysis of 166 consecutive patients who underwent PD at a tertiary referral care center was done. Ninety-eight patients who had received conventional perioperative management (conventional group) were compared with 68 patients who had received ERAS programme (ERAS group). The incidence of postoperative complications, length of stay, expenses, postoperative readmissions, and reoperation rates were compared.
RESULTS: A total of 166 patients underwent PD were analysed (68 patients in the ERAS group, and 98 patients in the conventional group). There were no statistical differences in mortality, reoperations, and readmissions. The ERAS group had a lower morbidity rate than the conventional group (50% vs. 90.8%; P=0.00), as well as a lower length of stay (7.5 vs 12 days; P=0.00). Delayed gastric emptying was significantly reduced in the ERAS group (0 vs. 11.2%; P=0.011). Pancreatic fistula (grade B,C) was significantly reduced in the ERAS group (14.7 vs 30.6%; P = 0.018). Median total hospital costs was also significantly reduced in the ERAS group (¥79790.40 vs ¥102982.81; P = 0.000).
CONCLUSION: The ERAS programme is feasible and safe in patients underwent PD, and it can reduce postoperative complications and improve clinical outcome.

PMID: 28132917 [PubMed - as supplied by publisher]

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