title: Early discharge after pancreatoduodenectomy: what helps and what prevents?
abstract: OBJECTIVE
  Shorter hospital stay after pancreatoduodenectomy (PD) is a desired goal. Implementation of enhanced recovery after surgery (ERAS) protocols can possibly help in achieving this target. We aimed to determine the factors influencing the successful implementation of ERAS protocols by analyzing their relation to the surrogate marker of enhanced recovery, namely, duration of hospital stay.
  
  
  METHODS
  A retrospective analysis of a prospectively maintained ERAS database of 208 consecutive patients who underwent PD at a tertiary referral care center was done.
  
  
  RESULTS
  Two hundred eight patients underwent a classical PD with a median duration of hospital stay of 8 days (range, 4-52 days) with an overall morbidity rate of 34.5% and a mortality rate of 3.8%. The 30-day readmission rate was 4% (8 patients). An elevated body mass index (relative risk, 1.098; 95% confidence interval, 1.015-1.188; P = 0.02) and respiratory comorbidities (relative risk, 8.024; 95% confidence interval, 2.018-31.904; P = 0.003) were independent factors resulting in a longer (>8 days) hospital stay.
  
  
  CONCLUSIONS
  Being overweight or obese and respiratory comorbidities are independent predictors of prolonged hospital stay despite the implementation of ERAS protocol. Hypoalbuminemia does not have a direct effect on hospital stay but may predispose the patient to the development of complications.
authors.affiliation: From the *Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, the Medicity, Gurgaon; and †Department of Biostatistics and Epidemiology, Tata Memorial Hospital, Parel, Mumbai, India.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Chaudhary
authors.forename: Savio G
authors.initials: SG
authors.lastname: Barreto
authors.forename: Sanjay D
authors.initials: SD
authors.lastname: Talole
authors.forename: Amanjeet
authors.initials: A
authors.lastname: Singh
authors.forename: Azhar
authors.initials: A
authors.lastname: Perwaiz
authors.forename: Tanveer
authors.initials: T
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000175:diagnosis / Q000453:epidemiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D020127:Recovery of Function; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult