Implementation of a Critical Pathway for Distal Pancreatectomy at an Academic Institution

Abstract

Implementation of a critical pathway for a complex procedure can be demonstrated to improve short-term outcomes at an academic institution. This improvement can be quantified and tracked and has implications for better utilization of resources and overall cost containment while maintaining or improving upon an already high level of care.

Adherence to ERAS elements in major visceral surgery—an observational pilot study

“…Previously published studies in pancreatic surgery described mobilization targets of up to 1 h on the first postoperative day (POD) and up to 4 h on POD 3, but it was not reported whether the targets were achieved [7,25,26]. In comparison, only 20-28 % of patients were mobilized on the first POD after liver surgery despite targets such as Bfour times daily^ [11,27,28].…”

“…For example, Kennedy et al recommended the removal of surgical drains after postoperative day 4 to 5 [25,26]. Other pancreatic ERAS programs scheduled the removal of the intraoperative drains after postoperative day 1 to 3 if possible [36].…”

Inter-device differences in monitoring for goal-directed fluid therapy

“…The results of this undertaking are the Enhanced Recovery After Surgery (ERAS) protocols we know today (Table 1). [2][3][4][5][6][7][8][9][10][11][12][13][14] All ERAS protocols typically share the following features:…”

Enhanced Recovery in Gastrointestinal Surgery: Upper Gastrointestinal Surgery

“…We found 8 articles that evaluated the results of the implementation of ERAS programs after pancreatic surgery [16,17,18,19,20,21,22,23] (table 1). None of the studies was a prospective randomized trial.…”

“…None of the studies was a prospective randomized trial. There were 4 prospective clinical series compared with historical controls [16,19,20,21], 1 case-control study [17], 2 prospective studies without a control group [18,23] and 1 retrospective study [22]. Four studies referred to the management of patients after pancreatoduodenectomy procedures, 3 studies included different types of pancreatic resection, and in a single study, only distal pancreatectomy was assessed.…”