title: Improvement of gastric emptying by enhanced recovery after pancreaticoduodenectomy.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) has improved postoperative outcomes particularly in colorectal surgery. This study aimed to assess compliance with an ERAS protocol and evaluate its effect on postoperative outcomes in patients undergoing pancreaticoduodenectomy.
  
  
  METHODS
  Fifty patients who had received conventional perioperative management from 2005 to 2009 (conventional group) were compared with 75 patients who had received perioperative care with an ERAS protocol (fast-track group) from 2010 to 2014. Mortality, complications, readmissions and length of hospital stay were evaluated and compared in the groups.
  
  
  RESULTS
  Compliance with each element of the ERAS protocol ranged from 74.7% to 100%. Uneventful patients had a significant higher adherence to the ERAS protocol (87.5% vs 40.7%; P<0.001). There were no significant differences in demographics and perioperative characteristics between the two groups. Patients in the fast-track group had a shorter time to remove the nasogastric tube, start liquid diet and solid food, pass flatus and stools, and remove drains. No difference was found in mortality, relaparotomy, readmission rates and overall morbidity. However, delayed gastric emptying and length of hospital stay were significantly reduced in the fast-track group. The independent effect of the ERAS protocol in reducing delayed gastric emptying and length of hospital stay was confirmed by multivariate analysis.
  
  
  CONCLUSIONS
  ERAS pathway was feasible and safe in improving gastric emptying, yielding an earlier postoperative recovery, and reducing the length of hospital stay.
authors.affiliation: Department of Surgery, "Konstantopouleio" General Hospital, 3-5 Agias Olgas Str., 14233 Athens, Greece. stratiszouros@gmail.com.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Zouros
authors.forename: Theodoros
authors.initials: T
authors.lastname: Liakakos
authors.forename: Anastasios
authors.initials: A
authors.lastname: Machairas
authors.forename: Paulos
authors.initials: P
authors.lastname: Patapis
authors.forename: Christos
authors.initials: C
authors.lastname: Agalianos
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D018589:Gastroparesis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006115:Greece; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D010349:Patient Compliance; D010359:Patient Readmission; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome