Abstract
Background
ERAS (enhanced recovery after surgery) has been demonstrated to improve perioperative outcomes. Guidelines for pancreatectomy have been available since 2012. However, they have not been widely adopted, likely due to morbidities historically associated with pancreatectomy. Thus, their effect on pancreatectomy outcomes has not been well documented. ERAS-pancreatectomy program was officially launched at our institution in 2022. We evaluated pancreatectomy outcomes before and after implementation of the ERAS program at a tertiary ERAS Qualified Center.
Methods
Pancreatectomy patients between 2020 and 2023 were evaluated via a retrospective review of a prospective database (ERAS Interactive Audit System by Encare). Patient demographics, perioperative factors, ERAS compliance rates, and postoperative outcomes were abstracted. Pre-ERAS and ERAS cohorts were compared.
Results
124 patients underwent pancreatectomy—81 were treated under ERAS. Majority (61.3%) underwent open pancreatoduodenectomy. Pre-ERAS patients had more open surgeries (97.7% v. 86.4%, P = .0436), longer OR times (P = .0224), and more EBL (P = .0111). ERAS patients had shorter LOS (mean 5.7 days v. 6.4, P = .0019), lower readmission rate (17.3% v. 34.9%, P = .0276), and lower all 30-day morbidity rate (34.6% v. 60.5%, P = .0056). ERAS patients had lower odds of all 30-day morbidity (OR = 0.43, P = .0429).
Discussion
ERAS interventions as a comprehensive program positively impact outcomes after pancreatectomy, with regards to LOS, readmission, and postoperative morbidity. ERAS improves outcomes by standardizing evidence-based care and eliminating variable non-evidence-based practices. ERAS protocols should be more widely adopted among high-volume pancreatectomy centers.
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