Enhanced Recovery after Surgery (ERAS) Implementation after Pancreaticoduodenectomy: Interim Result

Objective: Pancreaticoduodenectomy is a technically challenging surgery requiring longer period of recovery post operatively. This study aims to examine the implementation of an enhanced recovery after surgery (ERAS) protocol following pancreaticoduodenectomy. Methods: All patient undergone pancreaticoduodenectomy were managed following ERAS protocol. Outcomes measured include postoperative morbidity, mortality, length of stay and readmission rate within 30 days. Protocol targets were: removal of NG tube (PoD1), resumptions of oral fluids (PoD2), mobilization, removal of IV fluids, removal of H-J drain and urinary catheter and discharges from high dependency unit (PoD3), tolerating soft diet (PoD4), removal of P-J drain (PoD5), tolerating normal diet and full mobilization (PoD6) and hospital discharge (PoD7). Results: Data were collected for 15 patients. Rates of mortality, morbidity and readmission were 7%, 53% and 20% respectively. The median length of stay was 10 days. The proportions of patients achieving key targets were; 40% for NGT removal; 67% for resumption of oral fluids; 60% for urinary catheter removal; 53% for HDU discharge; 53% for tolerating diet; 67% for meeting mobility targets and 33% and 67% for H-J and P-J drain removal respectively. PoD 7, eight patients by PoD 11, discharged four patients and 2 complicated patients were discharged within day 17. Conclusion: ERAS protocol implementation in pancreaticoduodenectomy (PD) is feasible and safe. Achieving key target protocol was challenging. A further modification of the ERAS protocol may be needed to ensure more compliance.