Implementation of an enhanced recovery after surgery (ERAS) program following hepato- pancreato-biliary (HPB) surgeries – Our experience

Abstract

Introduction: Enhanced recovery after surgery (ERAS) program is an evidence based multimodal perioperative framework developed to reduce postoperative stress and accelerate recovery. Pancreatic and hepatobiliary surgery being highly complex procedures, our study aims in evaluating the role of ERAS protocol in these surgeries. Methodology: It is a prospective case study where ERAS protocol has been applied in patients undergoing pancreatic (n = 33) and hepatobiliary (n = 28) surgeries and results were compared with similar established studies. Results: Demographics, preoperative and operative variables have been assessed in both the groups and were compared with similar studies where no significant difference was noted. In pancreatic surgeries, the mean POPH ( postoperative hospital stay) was 8.7 days, only 2 patients had been re-operated and 9 had readmission. Pancreatic fistula was noted in 9 patients while no patients presented with biliary fistula. In hepatobiliary surgeries, the mean POPH was 7.68 days, only 5 patients had readmission. Complications like bile leak and liver failure are noted in only 2 patients. In both the groups there is decrease in flatus time, early removal of surgical drains, nasogastric tube and urinary catheter, early mobilisation and introduction of oral/ feeding jejunostomy feeds. The results were comparable. Discussion: Following ERAS protocols, the length of postoperative stay can be reduced significantly with consistent decrease in readmission and reoperation rates not compromising patient safety together with acceleration in gastrointestinal function in HPB surgeries. Conclusion: The ERAS program implemented in our study was found to be safe and feasible in HPB surgeries in reducing POPH.