title: Impact of fast-track concept elements in the classical pancreatic head resection (Kausch-Whipple procedure).
abstract: The aim of the study was to determine statistically significant factors with an impact on the early postoperative surgical outcome.
  
  
  METHODS
  The influence of applied fast-track components on surgical results and early postoperative outcome in 143 consecutive Kausch-Whipple procedure patients was evaluated in a single-center retrospective analysis of a prospective collection of patient-associated pre-, peri- and postoperative data from 1997-2006.
  
  
  RESULTS
  The in-hospital mortality rate was 2.8% (n=4). Fast-track measures were shown to have no effect on the morbidity rate in the multi-variate analysis. Over the study period, a decrease of intraoperative infusion volume from 14.2 mL/kg body weight/h in the first year to 10.7 mL/kg body weight/h in the last year was accompanied by an increase in patients requiring intraoperative catecholamines, up from 17% to 95%. The administration of ropivacain/sufentanil via thoracic peri-dural catheter injection initiated in 2000 and now considered the leading analgesic method, was used in 95% of the cases in 2006. Early extubation rate rose from 16.6% to 57.9%.
  
  
  CONCLUSIONS
  Fast-track aspects in the perioperative management have become more important in several surgical procedure even in those with a greater invasiveness such as Kausch-Whipple. However, such techniques used in peri-operative management of Kausch-Whipple pancreatic-head resections had no impact on the morbidity rate. In addition, the low in-hospital mortality rate was particularly attributed to surgical competence.
authors.affiliation: Institute for Quality Assurance in Medicine, Magdeburg, University Hospital, Magdeburg.
authors.forename: Ingo
authors.initials: I
authors.lastname: Gastinger
authors.forename: Frank
authors.initials: F
authors.lastname: Meyer
authors.forename: Thomas
authors.initials: T
authors.lastname: Lembcke
authors.forename: Uwe
authors.initials: U
authors.lastname: Schmidt
authors.forename: Henry
authors.initials: H
authors.lastname: Ptok
authors.forename: Hans
authors.initials: H
authors.lastname: Lippert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004434:Early Ambulation; D006801:Humans; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality*; D019990:Perioperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult