title: Impact of centralization of pancreaticoduodenectomy coupled with fast track recovery protocol: a comparative study from India.
abstract: BACKGROUND
  Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduodenectomy (PD) from an individual unit during transit from low to a high volume center.
  
  
  METHODS
  A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received conventional surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postoperative recovery, length of hospital stay and patient readmission requirement.
  
  
  RESULTS
  The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9+/-83.8 vs 997.4+/-151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit, P<0.001) and operative time taken (125 vs 245 minutes, P<0.001) were significantly lower in the fast track group. The frequency of pancreatic fistula (4.9% vs 13.0%) and delayed gastric emptying (7.0% vs 17.4%) was also significantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol.
  
  
  CONCLUSIONS
  This preliminary analysis suggests that the fast track approach might be beneficial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and significantly shortens their length of hospital stay.
authors.affiliation: Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India. omarjshah@yahoo.com.
authors.forename: Omar J
authors.initials: OJ
authors.lastname: Shah
authors.forename: Sadaf A
authors.initials: SA
authors.lastname: Bangri
authors.forename: Manmohan
authors.initials: M
authors.lastname: Singh
authors.forename: Reyaz A
authors.initials: RA
authors.lastname: Lattoo
authors.forename: Mohammad Y
authors.initials: MY
authors.lastname: Bhat
authors.forename: Feroze A
authors.initials: FA
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002497:Centralized Hospital Services / Q000458:organization & administration*; D005260:Female; D018589:Gastroparesis / Q000209:etiology; D006302:Health Services Research; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume / Q000458:organization & administration; D006801:Humans; D007194:India; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010359:Patient Readmission; D010360:Patient Transfer / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome