CONTEXT: Pancreatic surgery is often associated with significant morbidity, thus requiring high level of peri-operative care and long hospital stay. Multi-modal "enhanced recovery" or "fast-track" pathways have recently been introduced, aiming to expedite patient recovery. OBJECTIVE: To evaluate the evidence underpinning the use of fast-track pathways in the peri-operative care of patients undergoing pancreatic cancer surgery. RESULTS: The available evidence is limited, consisting of three retrospective studies that report median length of hospital stay between 7 and 13 days. No significant difference has been noted in re-admission or 30-day mortality rates between fast-track patients and historical controls, but there is a trend for higher overall complication rate for the fast-track groups. CONCLUSION: Implementation of an enhanced recovery pathway is feasible and can achieve shorter hospital stay and reduced costs, with no increase in re-admission or peri-operative mortality rates. There is, however, conflicting evidence on the physiological mechanisms that contribute to accelerated patient recovery. Certain safety issues associated with post-operative morbidity warrant rigorous evaluation in further prospective studies.
CONTEXT: Pancreatic surgery is often associated with significant morbidity, thus requiring high level of peri-operative care and long hospital stay. Multi-modal "enhanced recovery" or "fast-track" pathways have recently been introduced, aiming to expedite patient recovery. OBJECTIVE: To evaluate the evidence underpinning the use of fast-track pathways in the peri-operative care of patients undergoing pancreatic cancer surgery. RESULTS: The available evidence is limited, consisting of three retrospective studies that report median length of hospital stay between 7 and 13 days. No significant difference has been noted in re-admission or 30-day mortality rates between fast-track patients and historical controls, but there is a trend for higher overall complication rate for the fast-track groups. CONCLUSION: Implementation of an enhanced recovery pathway is feasible and can achieve shorter hospital stay and reduced costs, with no increase in re-admission or peri-operative mortality rates. There is, however, conflicting evidence on the physiological mechanisms that contribute to accelerated patient recovery. Certain safety issues associated with post-operative morbidity warrant rigorous evaluation in further prospective studies.
Authors: Kristoffer Lassen; Marielle M E Coolsen; Karem Slim; Francesco Carli; José E de Aguilar-Nascimento; Markus Schäfer; Rowan W Parks; Kenneth C H Fearon; Dileep N Lobo; Nicolas Demartines; Marco Braga; Olle Ljungqvist; Cornelis H C Dejong Journal: World J Surg Date: 2013-02 Impact factor: 3.352
Authors: Nichola Robertson; Peter James Gallacher; Natalie Peel; O James Garden; Mark Duxbury; Kristoffer Lassen; Rowan W Parks Journal: HPB (Oxford) Date: 2012-10 Impact factor: 3.647