Improving outcome after pancreaticoduodenectomy: experiences with implementing an enhanced recovery after surgery (ERAS) program

M.M. Coolsen, R.M. van Dam, A. Chigharoe, S.W.M. Olde Damink, C.H.C. Dejong

Research output: Contribution to journalArticleAcademicpeer-review

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 languageEnglish
Pages (from-to)177-184
Number of pages8
JournalDigestive Surgery
Volume31
Issue number3
DOIs
Publication statusPublished - 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

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