Implementing an enhanced recovery program after liver surgery. Lessons from 100 cases

Abstract

duodenopancreatectomies of the pre-ERAS era, perioperative data was assessed retrospectively. Results: The ERAS-protocol could be successfully implemented for pancreatic surgery in our hospital, the adherence to the protocol starting from 24.0% in the pre-ERAS era constantly increased to 67.9% in 2018. Regarding the different perioperative phases, the adherence is highest in the pre-operative phase: 94%, still 82% in the intra-operative phase but just 38% in the regarding the postoperative phase. Nevertheless, by the implementation of an ERAS-protocol in pancreatic surgery, median length of stay could be reduced by 4.4 days (19.3 vs. 14.9d) as well as severe complications by 5.5% (CDIIIa: 36.1 vs. 30.6%) without negatively affecting the readmission rate (11.1 vs. 7.4%). Pancreatic fistulas could be reduced by 6.5% (22.2 vs 15.7%), as well as postoperative obstipation by 9.4% (11.1 vs 1.7%). Evaluation of ASA and PPOS-SUM-Score indicates even patients of a slightly higher perioperative risk in the ERAS-group. Conclusion:The implementation of an ERAS-program for pancreatic surgery is feasible and successful. Pure extrapolation of data from other ERAS organ protocols is not sufficient. To further develop the ERAS-program we need to make sure that we are part of the same ERAS program. If everybody establishes its own modified ERAS-protocol, ERAS will not be more than a pure marketing tool.