K. A. Baugh1, G. Van Buren1, H. Tran Cao1, E. Silberfein1, C. Hsu1, C. Chai1, N. Massarweh1, W. Fisher1 1Baylor College Of Medicine,Michael E DeBakey Department Of Surgery,Houston, TX, USA
Introduction: We hypothesized that the implementation of an Enhanced Recovery After Surgery (ERAS) pathway targeting discharge on post-operative day (POD) 3 following pancreaticoduodenectomy (PD) would reduce length of stay (LOS) without affecting post-operative morbidity or mortality.
Methods: The ERAS pathway was implemented by one surgeon for 15 months starting in November 2016 (ERAS group). Outcomes in this group were compared to patients operated on by other surgeons at the same institution not following the pathway during the same time period (contemporary group) and to a retrospective cohort (retrospective group) of patients from the same single surgeon, between October 2014 to November 2015. A prospectively maintained database with documentation of all complications within 60 days of surgery was retrospectively reviewed. Analysis was performed using chi-squared or Fisher exact tests for categorical variables and Student’s T-tests or Mann Whitney tests for continuous variables.
Results: 117 patients were included in the study, 41 were in the ERAS group, 41 in the retrospective group and 35 in the contemporary group. There were no significant differences in patient demographics, co-morbidities, or fistula risk scores between groups. Median LOS was reduced by 40% in the ERAS group compared to the retrospective group (3 vs 5 days, P<0.001) and by 50% compared to the contemporary group (3 vs 6 days, P<0.001). In the ERAS group, 24% of patients experienced a significant complication (Accordion ≥grade 2) vs 37% in the retrospective group (P=0.23) and 29% in the contemporary group (0.68). There was no difference in clinically relevant post-operative pancreatic fistulas between groups (ERAS 7% vs retrospective group 10% vs contemporary group 3%; P=1, 0.62). Delayed gastric emptying occurred less in the ERAS group than the retrospective groups (4.9% vs 19.5%, P=0.048) but not when compared to the contemporary group (4.9% vs 8.6%, P= 0.66). There were no other differences in post-operative complications, rates of re-operation, or 60-day mortality.
Conclusion: Discharge on POD 3 following PD can be done safely and without impacting morbidity or mortality.