Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying

Abstract

Abstract Background Data on enhanced recovery programmes after pancreatic surgery are sparse. This retrospective cohort study, using historical controls, aimed to evaluate the impact of a fast-track programme after pancreaticoduodenectomy (PD). Methods Between 2004 and 2007, 252 patients undergoing PD were treated by a fast-track programme that included earlier postoperative feeding and mobilization. The patients were compared with an equally sized control group that received a traditional programme from 2000 to 2004. Outcome measures were morbidity, length of stay and readmission rate. Results The rates of pancreatic fistula and other intra-abdominal complications were similar in the two groups. Delayed gastric emptying (DGE) was significantly reduced in the fast-track group (13·9 versus 24·6 per cent; P = 0·004). The independent effect of the fast-track protocol in reducing DGE was confirmed by the multiple regression analysis (adjusted odds ratio 0·477, P = 0·005). Length of stay was reduced with the fast-track protocol (median 13 versus 15 days; P < 0·001), without increasing the readmission rate (7·1 versus 6·3 per cent; P = 0·865). Conclusion A fast-track programme after PD improves gastric emptying and reduces postoperative stay.