title: Perioperative care with fast-track management in patients undergoing pancreaticoduodenectomy.
abstract: BACKGROUND
  It has been considered that allowing patients to return to daily life earlier after surgery helps recovery of physiological function and reduces postoperative complications and hospital stay. We investigated the usefulness of fast-track management in perioperative care of patients undergoing pancreaticoduodenectomy (PD).
  
  
  METHODS
  Patients (n = 90) who received conventional perioperative management from 2005 to 2009 were included as the 'conventional group' (historical control group), and patients who received perioperative care with fast-track management (n = 100) from 2010 to March 2013 were included as the 'fast-track group'. To evaluate the efficacy of perioperative care with fast-track management, the incidence of postoperative complications and the length of hospital stay were compared between the two groups (comparative study). For statistical analysis, univariate analysis was performed using the χ (2) test or Fisher's exact test.
  
  
  RESULTS
  There was no significant difference between the two groups in sex, mean age, presence/absence of diabetes mellitus, preoperative drainage for jaundice, previous disease, operative procedure, mean duration of operation, or blood loss (p < 0.01). The incidence of surgical site infection in the conventional group and fast-track group was 28.9 and 14.0 %, respectively, with a significant difference between the two groups (p = 0.019). In addition, the incidence of pancreatic fistula (grade B, C) significantly differed between the two groups (27.8 % in the conventional group, 9.0 % in the fast-track group; p = 0.001). The mean postoperative hospital stay was 36.3 days in the conventional group and 21.9 days in the fast-track group (p < 0.001).
  
  
  CONCLUSIONS
  Perioperative care with fast-track management may reduce postoperative complications and decrease the length of hospital stay in patients undergoing PD.
authors.affiliation: Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan, koharubiyori@marianna-u.ac.jp.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Ryuiti
authors.initials: R
authors.lastname: Ooshima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koizumi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Katayama
authors.forename: Joe
authors.initials: J
authors.lastname: Sakurai
authors.forename: Taiji
authors.initials: T
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakano
authors.forename: Toshihide
authors.initials: T
authors.lastname: Imaizumi
authors.forename: Takehito
authors.initials: T
authors.lastname: Otsubo
mesh_terms: D000368:Aged; D004322:Drainage; D004434:Early Ambulation; D004435:Eating; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D012709:Serum Albumin / Q000378:metabolism; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors
chemical_list: D012709:Serum Albumin