title: Enhanced recovery after pancreatic surgery: a systematic review of the evidence.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) protocols have been shown to reduce hospital stay without compromising outcomes. Attempts to apply ERAS principles in the context of pancreatic surgery have generated encouraging results. A systematic review of the current evidence for ERAS following pancreatic surgery was conducted.
  
  
  METHODS
  A literature search of MEDLINE, CINAHL, EMBASE and the Cochrane Library was performed for articles describing postoperative clinical pathways in pancreatic surgery during the years 2000-2013. The keywords 'clinical pathway', 'critical pathway', 'fast-track', 'pancreas' and 'surgery' and their synonyms were used as search terms. Articles were selected for inclusion based on predefined criteria and ranked for quality. Details of the ERAS protocols and relevant outcomes were extracted and analysed.
  
  
  RESULTS
  Ten articles describing an ERAS protocol in pancreatic surgery were identified. The level of evidence was graded as low to moderate. No articles reported an adverse effect of an ERAS protocol for pancreatic surgery on perioperative morbidity or mortality. Length of stay (LoS) was decreased and readmission rates were found to be unchanged in six of seven studies that compared these outcomes.
  
  
  CONCLUSIONS
  Evidence indicates that ERAS protocols may be implemented in pancreatic surgery without compromising patient safety or increasing LoS. Enhanced recovery after surgery programmes in the context of pancreatic surgery should be standardized based upon the best available evidence, and trials of ERAS programmes involving multiple centres should be performed.
authors.affiliation: Division of General Surgery, Department of Surgery, Toronto, ON, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kagedan
authors.forename: Mahrosh
authors.initials: M
authors.lastname: Ahmed
authors.forename: Katharine S
authors.initials: KS
authors.lastname: Devitt
authors.forename: Alice C
authors.initials: AC
authors.lastname: Wei
mesh_terms: D006801:Humans; D007902:Length of Stay; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
references.citation: J Clin Epidemiol. 2011 Apr;64(4):401-6
references.pmid: 21208779
references.citation: Pancreatology. 2013 Jan-Feb;13(1):58-62
references.pmid: 23395571
references.citation: Br J Anaesth. 1997 May;78(5):606-17
references.pmid: 9175983
references.citation: Ann Surg Oncol. 2010 Oct;17(10):2537-44
references.pmid: 20625843
references.citation: CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
references.pmid: 22237781
references.citation: Langenbecks Arch Surg. 2008 Jul;393(4):449-57
references.pmid: 18297305
references.citation: Ann Surg. 2001 Oct;234(4):487-93; discussion 493-4
references.pmid: 11573042
references.citation: World J Surg. 2011 Dec;35(12):2586-93
references.pmid: 21882022
references.citation: Langenbecks Arch Surg. 2011 Mar;396(3):345-51
references.pmid: 20703500
references.citation: Ann Surg Oncol. 2000 Aug;7(7):484-9
references.pmid: 10947015
references.citation: HPB (Oxford). 2013 Sep;15(9):703-8
references.pmid: 23490096
references.citation: Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259
references.pmid: 22696318
references.citation: Ann Surg. 2014 Apr;259(4):605-12
references.pmid: 24374513
references.citation: JOP. 2009 Nov 05;10(6):646-50
references.pmid: 19890186
references.citation: HPB (Oxford). 2011 Dec;13(12):833-8
references.pmid: 22081917
references.citation: Ann R Coll Surg Engl. 2012 Jul;94(5):318-26
references.pmid: 22943226
references.citation: Ann Surg. 2006 Jul;244(1):10-5
references.pmid: 16794383
references.citation: World J Surg. 2013 May;37(5):1082-93
references.pmid: 23392451
references.citation: JOP. 2013 Jan 10;14(1):63-70
references.pmid: 23306337
references.citation: J Am Coll Surg. 2007 May;204(5):917-23; discussion 923-4
references.pmid: 17481510
references.citation: J Am Coll Surg. 2013 Apr;216(4):635-42; discussion 642-4
references.pmid: 23521944
references.citation: HPB (Oxford). 2012 Oct;14(10):700-8
references.pmid: 22954007
references.citation: Br J Surg. 2008 Nov;95(11):1387-93
references.pmid: 18844251
references.citation: J Am Coll Surg. 2007 Apr;204(4):570-9
references.pmid: 17382215
references.citation: World J Surg. 2013 Aug;37(8):1909-18
references.pmid: 23568250
references.citation: J Gastrointest Surg. 2007 Jul;11(7):880-7
references.pmid: 17440787
references.citation: Dig Surg. 2009;26(2):91-9
references.pmid: 19252405
references.citation: J Gastrointest Surg. 2009 May;13(5):938-44
references.pmid: 19190968
references.citation: Am Surg. 2012 Feb;78(2):225-9
references.pmid: 22369834
references.citation: Clin Nutr. 2012 Dec;31(6):817-30
references.pmid: 23079762
references.citation: Am J Surg. 2002 Jun;183(6):630-41
references.pmid: 12095591