title: Outcomes of an enhanced recovery after surgery programme for pancreaticoduodenectomy.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) has demonstrated in colorectal surgery a reduction in morbidity and length of stay without compromising security. Experience with ERAS programs in pancreatoduodenectomy (PD) is still limited. The aims of this study were first to evaluate the applicability of an ERAS program for PD patients in our hospital, and second to analyze the postoperative results.
  
  
  METHODS
  A retrospective study using a prospectively maintained database identified 41 consecutive PD included in an ERAS program. Key elements studied were early removal of tubes and drainages, early oral feeding and early mobilization. Variables studied were mortality, morbidity, perioperative data, length of stay, re-interventions and inpatient readmission. This group of patients was compared with an historic control group of 44 PD patients with a standard postoperative management.
  
  
  RESULTS
  A total of 85 pancreatoduodenectomies were analyzed (41 patients in the ERAS group, and 44 patients in the control group. General mortality was 2.4% (2 patients) belonging to the control group. There were no statistical differences in mortality, length of stay in intensive care, reoperationss, and readmissions. ERAS group had a lower morbidity rate than the control group (32 vs. 48%; P=.072), as well as a lower length of stay (14.2 vs. 18.7 days). All the key ERAS proposed elements were achieved.
  
  
  CONCLUSIONS
  ERAS programs may be implemented safely in pancreaticoduodenectomy. They may reduce the length of stay, unifying perioperative care and diminishing clinical variability and hospital costs.
authors.affiliation: Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España. Electronic address: rafa.morales@telefonica.net.
authors.forename: Rafael
authors.initials: R
authors.lastname: Morales Soriano
authors.affiliation: Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España.
authors.forename: Neus
authors.initials: N
authors.lastname: Esteve Pérez
authors.affiliation: Departamento de Biología y Ciencias de la Salud, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España.
authors.forename: Silvia
authors.initials: S
authors.lastname: Tejada Gavela
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Juan Carlos I, Madrid, España.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Cuadrado García
authors.affiliation: Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Rodríguez Pino
authors.affiliation: Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Morón Canis
authors.affiliation: Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España.
authors.forename: Xavier
authors.initials: X
authors.lastname: Molina Romero
authors.affiliation: Servicio de Cirugía General y Digestivo, Hospital Son Llátzer, Palma de Mallorca, Baleares, España.
authors.forename: José
authors.initials: J
authors.lastname: Muñoz Pérez
authors.affiliation: Unidad de Cirugía HBP, Servicio de Cirugía General y Digestivo, Hospital Son Espases, Palma de Mallorca, Baleares, España.
authors.forename: Xavier
authors.initials: X
authors.lastname: González Argente
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000534:rehabilitation*; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Duodenopancreatectomía cefálica; Enhanced recovery after surgery; Fast-track; Outcomes; Pancreatoduodenectomy; Rehabilitación multimodal precoz; Resultados