Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying.
BACKGROUND
Data on enhanced recovery programmes after pancreatic surgery are sparse. This retrospective cohort study, using historical controls, aimed to evaluate the impact of a fast-track programme after pancreaticoduodenectomy (PD).


METHODS
Between 2004 and 2007, 252 patients undergoing PD were treated by a fast-track programme that included earlier postoperative feeding and mobilization. The patients were compared with an equally sized control group that received a traditional programme from 2000 to 2004. Outcome measures were morbidity, length of stay and readmission rate.


RESULTS
The rates of pancreatic fistula and other intra-abdominal complications were similar in the two groups. Delayed gastric emptying (DGE) was significantly reduced in the fast-track group (13.9 versus 24.6 per cent; P = 0.004). The independent effect of the fast-track protocol in reducing DGE was confirmed by the multiple regression analysis (adjusted odds ratio 0.477, P = 0.005). Length of stay was reduced with the fast-track protocol (median 13 versus 15 days; P < 0.001), without increasing the readmission rate (7.1 versus 6.3 per cent; P = 0.865).


CONCLUSIONS
A fast-track programme after PD improves gastric emptying and reduces postoperative stay.
Pancreas Unit, Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy. balzano.gianpaolo@hsr.it
G
G
Balzano
A
A
Zerbi
M
M
Braga
S
S
Rocchetti
A A
AA
Beneduce
V
V
Di Carlo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000534:rehabilitation / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors