title: Improving outcome after pancreaticoduodenectomy: experiences with implementing an enhanced recovery after surgery (ERAS) program.
abstract: BACKGROUND
  Pancreaticoduodenectomies (PDs) are complex surgical procedures that require high-standard perioperative care. The objective of this study was to evaluate the effects of implementing an Enhanced Recovery After Surgery (ERAS) program for PD on patient outcome.
  
  
  METHODS
  230 patients undergoing PD in the Maastricht University Medical Centre between January 1995 and January 2012 were included. Group 1 (no ERAS; 1995-2005) received traditional care. From January 2006, several elements of an ERAS pathway for pancreatic surgery were implemented (group 2: 'ERAS-like'). From 2009 onwards the ERAS pathway was fully implemented (group 3: ERAS). Mortality, complications, readmissions and length of hospital stay (LOS) were evaluated in the subgroups and compared.
  
  
  RESULTS
  Median LOS was significantly reduced from 20 days in group 1 to 13 days in group 2 and 14 days in group 3 (p = 0.001). Median LOS of patients without complications was 16, 10 and 9 days in groups 1, 2 and 3, respectively (p < 0.0001). Over time, the average age of patients undergoing PD increased significantly. Complication rates as well as mortality and readmission rates did not change over time.
  
  
  CONCLUSIONS
  Implementing an ERAS program contributed to a decrease of LOS without compromising other outcomes. Mortality, morbidity and readmission rates stayed unchanged and more complications were managed non-operatively.
authors.affiliation: Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: Marielle M E
authors.initials: MM
authors.lastname: Coolsen
authors.forename: Ronald M
authors.initials: RM
authors.lastname: van Dam
authors.forename: Arwind
authors.initials: A
authors.lastname: Chigharoe
authors.forename: Steven W M
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: Cornelis H C
authors.initials: CH
authors.lastname: Dejong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D058996:Quality Improvement; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome