Abstract
BACKGROUND: Pancreaticoduodenectomies (PDs) are complex surgical procedures that require high-standard perioperative care. The objective of this study was to evaluate the effects of implementing an Enhanced Recovery After Surgery (ERAS) program for PD on patient outcome. METHODS: 230 patients undergoing PD in the Maastricht University Medical Centre between January 1995 and January 2012 were included. Group 1 (no ERAS; 1995-2005) received traditional care. From January 2006, several elements of an ERAS pathway for pancreatic surgery were implemented (group 2: 'ERAS-like'). From 2009 onwards the ERAS pathway was fully implemented (group 3: ERAS). Mortality, complications, readmissions and length of hospital stay (LOS) were evaluated in the subgroups and compared. RESULTS: Median LOS was significantly reduced from 20 days in group 1 to 13 days in group 2 and 14 days in group 3 (p = 0.001). Median LOS of patients without complications was 16, 10 and 9 days in groups 1, 2 and 3, respectively (p < 0.0001). Over time, the average age of patients undergoing PD increased significantly. Complication rates as well as mortality and readmission rates did not change over time. CONCLUSION: Implementing an ERAS program contributed to a decrease of LOS without compromising other outcomes. Mortality, morbidity and readmission rates stayed unchanged and more complications were managed non-operatively.
Original language | English |
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Pages (from-to) | 177-184 |
Number of pages | 8 |
Journal | Digestive Surgery |
Volume | 31 |
Issue number | 3 |
DOIs | |
Publication status | Published - 1 Jan 2014 |
Keywords
- Perioperative care
- Fast track
- Enhanced recovery
- Pancreaticoduodenectomy
- INTERNATIONAL STUDY-GROUP
- DRAIN AMYLASE LEVELS
- Y GASTRIC BYPASS
- LENGTH-OF-STAY
- PANCREATIC SURGERY
- GASTROJEJUNOSTOMY LEAKS
- HOSPITAL MORTALITY
- COLORECTAL SURGERY
- PERIOPERATIVE CARE
- DECREASING LENGTH