title: Enhanced Recovery After Surgery Protocols Are Valuable in Pancreas Surgery Patients.
abstract: BACKGROUND
  There is increasing interest in implementing comprehensive perioperative protocols, including preoperative optimization and education, perioperative goal-directed fluid management, and postoperative fast tracking, to enhance recovery after surgery. Data on the outcomes of these protocols in pancreatic surgery, however, are limited.
  
  
  METHODS
  A retrospective review of a prospectively maintained pancreas surgery database at a single institution from August 2012 to April 2015 was undertaken. An enhanced recovery protocol was initiated in October 2014, and patients were divided into groups according to preprotocol or postprotocol implementation. Preoperative, intraoperative, and postoperative data were tabulated. Statistical analysis was performed with Student's t-test and Fisher's exact tests, as well as equality of variances where appropriate, using SAS System software (SAS Institute).
  
  
  RESULTS
  Three hundred and seventy-eight patients (181 men, mean age 54 years, BMI 28 kg/m(2)) underwent elective pancreatic surgery during the study period, 297 patients preprotocol and 81 postprotocol. There were no significant differences in preoperative or intraoperative characteristics. Mean postoperative length of stay was significantly lower in the Enhanced Recovery After Surgery group (7.4 vs 9.2 days; p < 0.0001). Hospital costs were similarly lower in the Enhanced Recovery After Surgery group ($23,307.90 vs $27,387.80; p < 0.0001). Readmission (29% vs 32%) and pancreatic fistula (26% vs 28%) rates were similar between groups. Delayed gastric emptying was lower in the Enhanced Recovery After Surgery group (26% vs 13%; p = 0.03).
  
  
  CONCLUSIONS
  Implementation of an enhanced recovery after pancreatic surgery protocol significantly decreased length of stay and hospital cost without increasing readmission or morbidity. Despite patient complexity and the potential need for individualization of care, enhanced recovery protocols can be valuable and effective in high-risk patient populations, including pancreatic surgery patients.
authors.affiliation: Division of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC. Electronic address: morganka@musc.edu.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Morgan
authors.affiliation: Division of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: William P
authors.initials: WP
authors.lastname: Lancaster
authors.affiliation: Division of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Walters
authors.affiliation: Division of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Stefanie M
authors.initials: SM
authors.lastname: Owczarski
authors.affiliation: Department of Anesthesia, Medical University of South Carolina, Charleston, SC.
authors.forename: Carlee A
authors.initials: CA
authors.lastname: Clark
authors.affiliation: Department of Anesthesia, Medical University of South Carolina, Charleston, SC.
authors.forename: Julie R
authors.initials: JR
authors.lastname: McSwain
authors.affiliation: Division of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: David B
authors.initials: DB
authors.lastname: Adams
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D017558:Elective Surgical Procedures; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000473:pathology / Q000601:surgery*; D019990:Perioperative Care; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome