Current status of fast-track recovery pathways in pancreatic surgery.
BACKGROUND
Pancreatic surgery is often associated with significant morbidity, thus requiring high level of peri-operative care and long hospital stay. Multi-modal "enhanced recovery" or "fast-track" pathways have recently been introduced, aiming to expedite patient recovery.


OBJECTIVE
To evaluate the evidence underpinning the use of fast-track pathways in the peri-operative care of patients undergoing pancreatic cancer surgery.


RESULTS
The available evidence is limited, consisting of three retrospective studies that report median length of hospital stay between 7 and 13 days. No significant difference has been noted in re-admission or 30-day mortality rates between fast-track patients and historical controls, but there is a trend for higher overall complication rate for the fast-track groups.


CONCLUSIONS
Implementation of an enhanced recovery pathway is feasible and can achieve shorter hospital stay and reduced costs, with no increase in re-admission or peri-operative mortality rates. There is, however, conflicting evidence on the physiological mechanisms that contribute to accelerated patient recovery. Certain safety issues associated with post-operative morbidity warrant rigorous evaluation in further prospective studies.
Ypsilantis
Efthymios
E
Praseedom
Raaj K
RK
D002985:Clinical Protocols; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000401:mortality / Q000534:rehabilitation* / Q000639:trends*; D006801:Humans; D010182:Pancreatic Diseases / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome