• Wei Su, Fangyan Lu, Xiaoyu Zhang, Guogang Li, Wei Chen, Tao Ma, Shunliang Gao, Jianying Lou, Xueli Bai, and Tingbo Liang.
• aDepartment of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine bKey Laboratory of Pancreatic Disease of Zhejiang Province, Hangzhou cZhejiang University, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
• Medicine (Baltimore). 2017 Oct 1; 96 (41): e8206.

AbstractEnhanced recovery after surgery (ERAS) programs have been shown to decrease postoperative complications and hospital stay in pancreaticoduodenectomy. However, no studies concerned recovery after discharge except readmission. This study evaluated an ERAS program for pancreaticoduodenectomy from hospital to home.A prospective ERAS cohort undergoing elective pancreaticoduodenectomy was compared with a retrospective control group in terms of postoperative complications and hospital stay, and home recovery after discharge. Propensity-score matching was used to balance their baselines.Two groups of 31 patients with similar propensity scores were established. Postoperative morbidities were 18 of 31 and 26 of 31 in the ERAS and control groups, respectively (P = .06). Patients in the ERAS group suffered from fewer cardiovascular complications (3/31 vs 11/31; P = .04) and intestinal dysbacteriosis (4/31 vs 13/31; P = .04). Median postoperative hospital stay was shorter in the ERAS group (8 vs 16 days; P < .001). Although the 2 groups were similar in terms of sleep, defecation, vigor, performance status, and pain control in first month after discharge, patients in the ERAS group enjoyed better food intake recovery (18/31 vs 5/31 in first week, P = .002; 22/31 vs 9/31 in second week, P = .008; 23/31 vs 13/31 in fourth week, P = .01) and fewer weight loss (10/31 vs 19/31; P = .05). Multivariate analyses showed that both improvements were associated with no bowel preparation.ERAS implementation in selected patients undergoing pancreaticoduodenectomy could promise better outcomes, not only in the hospital but also at home in the short term.

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