A modified fast-track program for pancreatic surgery: a prospective single-center experience.
OBJECTIVE
The objective of this study is to evaluate the impact of a fast-track protocol in a high-volume center for patients with pancreatic disorders.


BACKGROUND
The concept of fast-track surgery allowing accelerated postoperative recovery is accepted in colorectal surgery, but efficacy data are only preliminary for patients undergoing major pancreatic surgery. We aimed to evaluate the impact of a modified fast-track protocol in a high-volume center for patients with pancreatic disorders.


METHODS
Between February 2005 and January 2010, 145 subjects had resective pancreatic surgery and were enrolled in the program. Essential features of the program were no preanaesthetic medication, upper and lower air-warming device, avoidance of excessive i.v. fluids perioperatively, effective control of pain, early reinstitution of oral feeding, and immediate mobilization and restoration of bowel function following surgery. Outcome measures were postoperative complications such as pancreatic fistula, delayed gastric emptying, biliary leak, intra-abdominal abscess, post-pancreatectomy hemorrhage, acute pancreatitis, wound infection, 30-day mortality, postoperative hospital stay, and readmission rates.


RESULTS
On average, patients were discharged on postoperative day 10 (range 6-69), with a 30-day readmission rate of 6.2%. Percentage of patients with at least one complication was 38.6%. Pancreatic anastomotic leakage occurred in seven of 101 pancreatico-jejunostomies, and biliary leak in three of 109 biliary jejunostomies. Postoperative hemorrhage occurred in ten (6.9%) patients and wound infection in nine (6.2%) cases. In-hospital mortality was 2.7%. Fast-track parameters, such as normal food and first stool, correlated significantly with early discharge (<0.05). At multivariate analysis, lack of jaundice, and resumption of normal diet by the 5th postoperative day were independent factors of early discharge.


CONCLUSIONS
Fast-track programs are feasible, easy, and also applicable for patients undergoing a major surgery such as pancreatic resection.
di Sebastiano
Pierluigi
P
Department of Surgery, IRCCS-Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy. p.disebastiano@operapadrepio.it
Festa
Leonardina
L
De Bonis
Antonio
A
Ciuffreda
Andrea
A
Valvano
Maria Rosa
MR
Andriulli
Angelo
A
di Mola
F Francesco
FF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010182:Pancreatic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery; D010351:Patient Discharge / Q000639:trends; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D015397:Program Evaluation; D011446:Prospective Studies; D013997:Time Factors