title: Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: feasibility, safety and cost analysis.
abstract: OBJECTIVE
  The adoption of laparoscopy for distal pancreatectomy has proven to substantially improve short-term outcomes. Stress response after major surgery can be further minimized within an enhanced recovery programme (ERP). However, data on the potential benefit of an ERP for laparoscopic distal pancreatectomy are still lacking. The aim was to assess the feasibility, safety and cost of ERP for patients undergoing laparoscopic distal pancreatectomy.
  
  
  METHODS
  This is a case-control study from a Tertiary University Hospital. Sixty-six consecutive patients who underwent laparoscopic distal pancreatectomy were analyzed. Twenty-two patients were enrolled for the ERP and compared with previous consecutive 44 patients managed traditionally (1:2 ratio). Operative details, post-operative outcome and cost analysis were compared in the two groups.
  
  
  RESULTS
  Patients enrolled in the ERP had similar intraoperative blood loss (median 165 ml vs. 200 ml; p = 0.176), operation time (225 min vs. 210 min; p = 0.633), time to remove naso-gastric tube (1 vs. 1 day; p = 0.081) but significantly shorter time to mobilization (median 1 vs. 2 days; p = 0.0001), start solid diet (2 vs. 3 days; p = 0004), and pass stools (3 vs. 5 days; p = 0.002) compared to the control group. Median length of stay was significantly shorter in the ERP group (3 vs. 6 days; p < 0.0001). No significant difference in readmission or complication rate was observed. Cost analysis was significantly in favor of the ERP group (p = 0.0004).
  
  
  CONCLUSIONS
  Implementation of ERP optimizes outcomes for laparoscopic distal pancreatectomy with significant earlier return to normal gut function, reduced length of stay and cost saving.
authors: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors: John
authors: J
authors: Richardson
authors: University Hospital Southampton NHS Foundation Trust, Southampton, UK. Electronic address: difabiof@hotmail.it.
authors: Francesco
authors: F
authors: Di Fabio
authors: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors: Hannah
authors: H
authors: Clarke
authors: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors: Mohammed
authors: M
authors: Bajalan
authors: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors: Joe
authors: J
authors: Davids
authors: University Hospital Southampton NHS Foundation Trust, Southampton, UK. Electronic address: Mohammed.AbuHilal@uhs.nhs.uk.
authors: Mohammed
authors: M
authors: Abu Hilal
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D004032:Diet; D004434:Early Ambulation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D020127:Recovery of Function; D016896:Treatment Outcome
keywords: Costs analysis; Distal pancreatectomy; Enhanced recovery; Fast-track; Laparoscopy; Outcome