Implementation of an enhanced recovery programme following pancreaticoduodenectomy

Nichola Robertson, Peter James Gallacher, Natalie Peel, O. James Garden, Mark Duxbury, Kristoffer Lassen, Rowan W. Parks*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The aim of this prospective study was to investigate the implementation of an enhanced recovery after surgery (ERAS) programme following pancreaticoduodenectomy (PD).

Methods: Patients undergoing PD were managed according to an ERAS protocol. Outcome measures included postoperative mortality, morbidity, hospitalization and 30-day readmission rate. Key protocol targets were: nasogastric tube (NGT) removal [postoperative day (PoD) 1]; resumption of oral fluids (PoD 1); urinary catheter removal (PoD 3); high-dependency unit (HDU) discharge (PoD 3); tolerating diet (PoD 4); drain removal (PoD 5), and hospital discharge (PoD 6).

Results: Data were collected for 50 patients (24 male; median age 67 years). Rates of mortality, morbidity and readmission were 4%, 46% and 4%, respectively. The median length of postoperative hospitalization was 10 days. The proportions of patients achieving key targets were: 78% for NGT removal; 82% for resumption of oral fluids; 48% for urinary catheter removal; 82% for HDU discharge; 86% for tolerating diet; 84% for meeting mobility targets, and 72% for drain removal. One patient was discharged by PoD 6, eight patients by PoD 7, 15 patients by PoD 8 and 26 patients (52%) by PoD 10. Discharge was delayed in 16 patients for social or transport-related reasons.

Conclusions: The ERAS protocol was implemented safely. Achieving certain targets was challenging. Non-medical causes remain a significant factor in delayed discharge following PD.

Original languageEnglish
Pages (from-to)700-708
Number of pages9
JournalHPB
Volume14
Issue number10
DOIs
Publication statusPublished - Oct 2012

Keywords

  • CONSECUTIVE PANCREATICODUODENECTOMIES
  • PANCREATIC SURGERY ISGPS
  • HOSPITAL VOLUME
  • COLORECTAL SURGERY
  • RESECTION
  • FAST-TRACK PROGRAM
  • EPIDURAL ANALGESIA
  • INTERNATIONAL STUDY-GROUP
  • HEALTH OUTCOMES
  • RANDOMIZED MULTICENTER TRIAL

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