title: Implementation of enhanced recovery programme after pancreatoduodenectomy: a single-centre UK pilot study.
abstract: BACKGROUND
  Data on enhanced recovery programmes after pancreatoduodenectomy (ERP-PD) is limited. The aim of this pilot study was to evaluate the feasibility, safety and clinical outcomes of ERP-PD when implemented at a high-volume UK university referral centre.
  
  
  METHODS
  This was an observational single-surgeon case-control study (before-and-after pathway). A total of 20 consecutive patients were prospectively enrolled for the ERP-PD and compared with 24 consecutive patients previously treated during an equal time frame.
  
  
  RESULTS
  Patients in the ERP-PD group had a significant shorter time to remove naso-gastric tube (median of 5 vs. 7 days, p = 0.0001), start liquid diet (median of 2 vs. 5 days, p < 0.0001), start solid food (median of 4 vs. 9 days, p < 0.0001), pass stools (median of 6 vs. 7 days, p = 0.002), and had shorter length of stay (median of 8.5 days vs. 13 days, p = 0.015) compared to the pre-pathway group. Postoperative complications were overall less frequent but not significantly different in the ERP-PD group (p = 0.077). No difference in mortality and readmission rates was found.
  
  
  CONCLUSIONS
  Our findings support the feasibility and safety of ERP-PD. Improved patients' outcomes, significant bed day savings and increase National Health Service productivity are anticipated with implementation of ERP-PD on a larger scale.
authors: Hepato-biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK. Mohammed.AbuHilal@uhs.nhs.uk
authors: Mohammed
authors: M
authors: Abu Hilal
authors: Francesco
authors: F
authors: Di Fabio
authors: Abdallah
authors: A
authors: Badran
authors: Hani
authors: H
authors: Alsaati
authors: Hannah
authors: H
authors: Clarke
authors: Imogen
authors: I
authors: Fecher
authors: Thomas H
authors: TH
authors: Armstrong
authors: Colin D
authors: CD
authors: Johnson
authors: Neil W
authors: NW
authors: Pearce
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000534:rehabilitation*; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D010865:Pilot Projects; D011183:Postoperative Complications