Comparative outcomes of early and standard discharge in patients undergoing pancreatoduodenectomy

Abstract

Introduction: Literature with respect to enhanced recovery after surgery (ERAS) protocols in patients undergoing pancreatoduodenectomy (PD) is limited to small retrospective series. Using early discharge (ED) as a surrogate for ERAS, we utilized a national database to compare perioperative outcomes in patients undergoing early and standard discharge (SD) after PD. Method: Patients who underwent elective PD were extracted from the ACS-NSQIP 2014 and 2015 datasets. After excluding all patients who developed complications prior to discharge, patients were divided into either ED (0–5 days) from the index operation, or SD (Days 6–10). The primary outcomes were all-cause morbidity within 30 days and readmission rates, whilst the incidence of specific complications were considered secondary outcomes. Results: In total, 2759 patients met inclusion criteria, of whom 495 patients (18 %) constituted the ED group. The ED group included patients with a younger median age (64 vs 65 years; p = 0.003), and fewer patients with hypertension (41.8% vs 51.4%; p < 0.001), but were similar in all other preoperative characteristics investigated. The ED group had a lower median operative time (324 vs 347 min; p < 0.001). In unadjusted analysis, there were no differences between the two groups with respect to 30-day all-cause morbidity (15.2% vs 16.8%; p = 0.40), or serious morbidity (0.8% vs 1.1%; p = 0.8). The 30-day readmission rate was lower in the ED group but not statistically so (10.5% vs 13%; p = 0.16). Conclusions: Early discharge, and by extrapolation ERAS, in patients undergoing pancreatoduodenectomy is safe without additional risk of short-term morbidity, or increased risk of readmission.