title: Enhanced recovery pathway in patients undergoing distal pancreatectomy: a case-matched study.
abstract: Enhanced recovery (ER) pathways have improved outcomes across multiple surgical specialties, but reports concerning their application in distal pancreatectomy (DP) are lacking. The aim of this study was to assess compliance with an ER protocol and its impact on short-term outcomes in patients undergoing DP.
  
  
  
  Prospectively collected data were reviewed. One hundred consecutive patients undergoing DP were treated within an ER pathway comprising 18 care elements. Each patient was matched 1:1 with a patient treated with usual perioperative care. Match criteria were age, BMI, ASA score, lesion site, and type of disease.
  
  
  
  Adherence to ER items ranged from 15% for intraoperative restrictive fluids to 100% for intraoperative warming, antibiotic and anti-thrombotic prophylaxis. Patients in ER group experienced earlier recovery of gastrointestinal function (2 vs. 3 days, p < 0.001), oral intake (2 vs. 4 days, p < 0.001), and suspension of intravenous infusions (3 vs. 5 days, p < 0.001). Overall morbidity was similar in the two groups (72% vs. 78%). Length of hospital stay (LOS) was reduced in ER patients without postoperative complications (6.7 ± 1.2 vs. 7.6 ± 1.6 days, p = 0.041).
  
  
  
  An ER pathway for DP yielded an earlier postoperative recovery and shortened LOS in uneventful patients. Postoperative morbidity and readmissions were similar in both groups.
authors.affiliation: Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pecorelli
authors.affiliation: Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capretti
authors.affiliation: Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.affiliation: Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Castoldi
authors.affiliation: Department of Surgery, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Maspero
authors.affiliation: Department of Anesthesiology, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Beretta
authors.affiliation: Department of Surgery, Vita-Salute University, San Raffaele Hospital, Milan, Italy. Electronic address: braga.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D019091:Critical Pathways / Q000592:standards; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000592:standards; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology; D017410:Practice Guidelines as Topic; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome