title: Reducing postoperative complications and improving clinical outcome: Enhanced recovery after surgery in pancreaticoduodenectomy - A retrospective cohort study.
abstract: BACKGROUND
  An enhanced recovery after surgery (ERAS) programme aims to reduce the stress response to surgery and thereby accelerate recovery. The experience of implementing the ERAS programmes in pancreatoduodenectomy (PD) is relatively limited. The aim of this study was to evaluate the feasibility, safety and clinical outcomes of the ERAS programme after PD at a high-volume Chinese university referral centre.
  
  
  METHODS
  Between September 2014 and July 2016, a retrospective analysis of 166 consecutive patients who underwent PD at a tertiary referral care center was carried out. Ninety-eight patients who received conventional perioperative management (the conventional group) were compared with 68 patients who received ERAS programme (the ERAS group). The incidences of postoperative complications, length of stay, expenses, postoperative readmissions, and reoperation rates were compared.
  
  
  RESULTS
  A total of 166 patients who underwent PD were analysed (68 patients in the ERAS group, and 98 patients in the conventional group). There were no significant differences in mortality, reoperation, and readmission rates. The ERAS group had a lower morbidity rate than the conventional group (50% vs. 90.8%; P = 0.00), as well as a shorter length of hospital stay (7.5 vs 12 days; P = 0.00). Delayed gastric emptying was significantly reduced in the ERAS group (0 vs. 11.2%; P = 0.011). Pancreatic fistula (grade B,C) was significantly reduced in the ERAS group (14.7 vs 30.6%; P = 0.018). The median total hospital cost was also significantly reduced in the ERAS group (¥79790.40 vs ¥102982.81; P = 0.000).
  
  
  CONCLUSIONS
  The ERAS programme is feasible and safe in patients who underwent PD, and it can reduce postoperative complications and improve clinical outcomes.
authors.affiliation: Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Juntao
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Yongjian
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China. Electronic address: surgeonfu@163.com.
authors.forename: Deliang
authors.initials: D
authors.lastname: Fu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005240:Feasibility Studies; D005260:Female; D018589:Gastroparesis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007422:Intestines; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality / Q000534:rehabilitation; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D015397:Program Evaluation; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
keywords: Enhanced recovery after surgery; Fast-track surgery; Pancreatoduodenectomy