Clinical effect of the enhanced recovery after surgery strategy for pancreaticoduodenectomy

Objective To investigate the clinical effect and safety of the enhanced recovery after surgery ( ERAS) strategy in the perioperative period of pancreaticoduodenectomy ( PD) . Methods A retrospective analysis was performed for the clinical data of 100 patients who underwent PD in The First Hospital of Jilin University from August 2012 to July 2016. The patients were divided into ERAS group and control group according to the management mode during the perioperative period, with 50 patients in each group. The patients in the control group were given routine management, and those in the ERAS group were given ERAS management. The two groups were compared in terms of mortality rate, incidence rate of complications, time of operation, diet, intestinal function, length of postoperative hospital stay, hospital costs, secondary surgical intervention, and readmission rate. The t-test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results Two patients in the control group and one in the ERAS group died after surgery. There were no significant differences in mortality, reoperation, and readmission rates between the two groups ( all P > 0. 05) . Compared with the control group, the ERAS group had a significantly lower incidence rate of complications ( 31. 0% vs 56. 3%, χ2= 5. 84, P = 0. 016) and significantly shorter time to first flatus, time to diet, time to ambulation, and time to removal of drainage tube and other tubes ( all P < 0. 001) . There were significant differences between the ERAS group and the control group in length of hospital stay ( 14. 3 ± 1. 2 d vs 18. 5 ± 1. 8 d, t = 13. 73, P < 0. 001) and total hospital costs [10. 7 ± 1. 4 ten thousand yuan vs 13. 2 ± 4. 1 ten thousand yuan, t = 4. 08, P < 0. 001]. Conclusion The ERAS strategy is safe and effective in the perioperative period of PD and can significantly reduce hospital costs, shorten the length of hospital stay, standardize perioperative management, diminish clinical variability, and thus help patients to achieve enhanced recovery. Therefore, it holds promise for clinical application.