Implementation and Outcomes of an Enhanced Recovery after Surgery (ERAS) Programme in a Newly Established Unit of Pancreatic Surgery

Abstract

Introduction: A prospective single centre cohort evaluation of a newly established pancreatic surgery programme following ERAS principles was performed. Method: All patients were managed with a perioperative ERAS protocol. Preoperative interventions included prehabilitation with physical exercise and respiratory physiotherapy, fragility assessment, detection and optimisation of anaemia, nutritional evaluation and supplementation of malnourished patients and intake of a complex clear carbohydrate-rich drink up to 2 hours before surgery in all patients. Intraoperative interventions were based on peridural catheterisation, non-opioid analgesia, antiemetics, and intraoperative removal of nasogastric tubes. Postoperative interventions consisted in early (<6 hours) oral diet, early scheduled mobilisation, respiratory physiotherapy, optimal control of pain and early drains and urinary catheters removal. The outcomes were compliance to the protocol, morbidity, mortality, postoperative LOS and readmission rate. Results: Between November 2017 and January 2020, 84 patients were included. Pancreatoduodenectomies 62 (73.8%), distal pancreatectomies 17 (20.2%), Beger procedures 3 (3.6%), total pancreatoduodenectomies 2 (2.4%), central pancreatectomies 1 (1.2%). 66 (78.6%) were open, 13 (15.3%) robotic, 2 (2.4%) laparoscopic and 4 (4.8%) were conversions either from laparoscopic or robotic procedures. Compliance of ERAS preoperative and intraoperative protocol items were both 100%, while compliance of ERAS postperative items was 81%. Major morbidity rate (Clavien>III) was 28.2%. Mean Comprehensive Complication Index Score (CCI) was 27.61. Mortality was 3.5%. Median postoperative LOS was 11 days (2-87). Readmission rate was 7,1%. Conclusion: ERAS can be implemented in a. newly established unit of pancreatic surgery without compromising patient safety and with similar outcomes to the reported in the literature.