Enhanced recovery after surgery versus conventional recovery strategies for pancreatic surgery

Abstract

Objectives: The Enhanced Recovery After Surgery (ERAS) pathway has reduced morbidity and length-of-stay in hospital in orthopedics, colorectal and pelvic surgery. However, its application in pancreatic surgery remains controversial. We initiated an ERAS programme in a high-volume pancreas centre in China to evaluate its safety and efficiency. Methods: Based on the ERAS guidelines and the updated evidences, a unique institutional ERAS programme was developed in combination with our current practice. The ERAS protocol was applied in 343 consecutive patients undergoing pancreatic surgery. Patients (n=88) who received conventional recovery strategies were included as the control group. Achievement of management goals and short-term postoperative complications were analysed. Results: No adverse effect related to ERAS items occurred. Compliance with perioperative items ranged from 43 to 100%. The proportions of patients achieving key targets were: 60% for NGT removal; 94% for urethral catheter removal; 98% for resumption of water on POD1; 80% for resumption of oral fluids on POD2; 58% for tolerating diet on POD4; 84-90% for meeting mobility targets, and 50% for drain removal. The ERAS group had an earlier recovery of oral feeding (p<0.01), mobilisation (p<0.01), NGT removal (p<0.05), and urethral catheter removal (p<0.01). There was no difference between ERAS and control group in mortality, overall morbidity and major complication rates. The mean postoperative hospital stay was 19.6 days in the conventional group and 16.2 days in the ERAS group (p<0.05). Meanwhile, the ERAS pathway significantly reduced hospitalisation costs. Conclusion: ERAS programme can be safely implemented in pancreatic surgery with an earlier postoperative recovery and a shorter LOS than conventional recovery strategies. Monitoring of programme running and appropriate interventions can improve executive ability of the ERAS system during its initiation phase. Disclosure of interest: None declared.