A modified fast-track program for pancreatic surgery: A prospective single-center experience

Pierluigi Di Sebastiano, Leonardina Festa, Antonio De Bonis, Andrea Ciuffreda, Maria Rosa Valvano, Angelo Andriulli, F. Francesco Di Mola

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The objective of this study is to evaluate the impact of a fast-track protocol in a high-volume center for patients with pancreatic disorders. Background: The concept of fast-track surgery allowing accelerated postoperative recovery is accepted in colorectal surgery, but efficacy data are only preliminary for patients undergoing major pancreatic surgery. We aimed to evaluate the impact of a modified fast-track protocol in a highvolume center for patients with pancreatic disorders. Methods: Between February 2005 and January 2010, 145 subjects had resective pancreatic surgery and were enrolled in the program. Essential features of the program were no preanaesthetic medication, upper and lower air-warming device, avoidance of excessive i.v. fluids perioperatively, effective control of pain, early reinstitution of oral feeding, and immediate mobilization and restoration of bowel function following surgery. Outcome measures were postoperative complications such as pancreatic fistula, delayed gastric emptying, biliary leak, intra-abdominal abscess, post-pancreatectomy hemorrhage, acute pancreatitis, wound infection, 30-day mortality, postoperative hospital stay, and readmission rates. Results: On average, patients were discharged on postoperative day 10 (range 6-69), with a 30-day readmission rate of 6.2%. Percentage of patients with at least one complication was 38.6%. Pancreatic anastomotic leakage occurred in seven of 101 pancreatico-jejunostomies, and biliary leak in three of 109 biliary jejunostomies. Postoperative hemorrhage occurred in ten (6.9%) patients and wound infection in nine (6.2%) cases. In-hospital mortality was 2.7%. Fasttrack parameters, such as normal food and first stool, correlated significantly with early discharge (

Original languageEnglish
Pages (from-to)345-351
Number of pages7
JournalLangenbeck's Archives of Surgery
Volume396
Issue number3
DOIs
Publication statusPublished - Mar 2011

Keywords

  • Chronic pancreatitis
  • Complications
  • Fast-track surgery
  • Hospital stay
  • Pancreatic cancer

ASJC Scopus subject areas

  • Surgery

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