title: Implementation of an enhanced recovery programme following pancreaticoduodenectomy.
abstract: OBJECTIVE
  The aim of this prospective study was to investigate the implementation of an enhanced recovery after surgery (ERAS) programme following pancreaticoduodenectomy (PD).
  
  
  METHODS
  Patients undergoing PD were managed according to an ERAS protocol. Outcome measures included postoperative mortality, morbidity, hospitalization and 30-day readmission rate. Key protocol targets were: nasogastric tube (NGT) removal [postoperative day (PoD) 1]; resumption of oral fluids (PoD 1); urinary catheter removal (PoD 3); high-dependency unit (HDU) discharge (PoD 3); tolerating diet (PoD 4); drain removal (PoD 5), and hospital discharge (PoD 6).
  
  
  RESULTS
  Data were collected for 50 patients (24 male; median age 67 years). Rates of mortality, morbidity and readmission were 4%, 46% and 4%, respectively. The median length of postoperative hospitalization was 10 days. The proportions of patients achieving key targets were: 78% for NGT removal; 82% for resumption of oral fluids; 48% for urinary catheter removal; 82% for HDU discharge; 86% for tolerating diet; 84% for meeting mobility targets, and 72% for drain removal. One patient was discharged by PoD 6, eight patients by PoD 7, 15 patients by PoD 8 and 26 patients (52%) by PoD 10. Discharge was delayed in 16 patients for social or transport-related reasons.
  
  
  CONCLUSIONS
  The ERAS protocol was implemented safely. Achieving certain targets was challenging. Non-medical causes remain a significant factor in delayed discharge following PD.
authors.affiliation: Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Nichola
authors.initials: N
authors.lastname: Robertson
authors.forename: Peter James
authors.initials: PJ
authors.lastname: Gallacher
authors.forename: Natalie
authors.initials: N
authors.lastname: Peel
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
authors.forename: Mark
authors.initials: M
authors.lastname: Duxbury
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Lassen
authors.forename: Rowan W
authors.initials: RW
authors.lastname: Parks
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D020878:Device Removal; D004032:Diet; D004322:Drainage / Q000295:instrumentation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation; D007902:Length of Stay; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010351:Patient Discharge; D010359:Patient Readmission; D010865:Pilot Projects; D015397:Program Evaluation; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000295:instrumentation; D062885:Urinary Catheters
chemical_list: D000700:Analgesics