title: Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS(®)) pathways have reduced morbidity and length of hospital stay (LOS) in orthopedics, bariatric, and colorectal surgery. New perioperative care protocols have been tested in patients undergoing pancreaticoduodenectomy (PD), with controversial results on morbidity. Incomplete data about ERAS items compliance have been reported. The aim of this study was to assess compliance with an ERAS protocol and its impact on short-term outcome in patients undergoing PD.
  
  
  METHODS
  A comprehensive ERAS protocol was applied in 115 consecutive patients undergoing PD. Each ERAS patient was matched with one patient who received standard perioperative care. Match criteria were age, gender, malignant/benign disease, and PD-specific prognostic score.
  
  
  RESULTS
  No adverse effect related to ERAS items occurred. Compliance with postoperative items ranged between 38 and 66 %. The ERAS group had an earlier recovery of mobilization (p < 0.001), oral feeding (p < 0.001), gut motility (p < 0.001), and an earlier suspension of intravenous fluids (p = 0.041). No difference between ERAS and control group was found in mortality, overall morbidity, and major complication rates. Subgroup analysis showed that 43/60 (71 %) patients with early postoperative low compliance with the ERAS pathway had complications. The ERAS pathway significantly shortened LOS in uneventful patients or those with minor complications (11.2 vs. 13.7 days, p = 0.001).
  
  
  CONCLUSIONS
  The ERAS pathway was feasible and safe, yielding an earlier postoperative recovery. An ERAS protocol should be implemented in patients undergoing PD; however, patients with early postoperative low compliance should be carefully managed.
authors.affiliation: Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy, braga.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pecorelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ariotti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capretti
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Greco
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.forename: Renato
authors.initials: R
authors.lastname: Castoldi
authors.forename: Luigi
authors.initials: L
authors.lastname: Beretta
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D004434:Early Ambulation; D004750:Enteral Nutrition; D005260:Female; D005440:Fluid Therapy; D005769:Gastrointestinal Motility; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D019990:Perioperative Care / Q000379:methods*; D011184:Postoperative Period; D017410:Practice Guidelines as Topic; D020127:Recovery of Function