The economics of recovery after pancreatic surgery: detailed cost minimization analysis of an enhanced recovery program.

HPB (Oxford). 2017 Nov;19(11):1026-1033. 

What is already known:

There have been quite a few successful published programmes for pancreatic surgery as well as published ERAS guidelines. But less is known about the economic benefits of these programmes.

What this paper adds:

This was a Canadian retrospective cost minimization analysis of patients undergoing pancreaticoduodenectomy with an ERAS programme versus standard care. Despite only a small reduction in total length of stay (10 vs 11 days, p=0.003), there was a pretty impressive cost saving of over 13,000 Canadian dollars per patient (including readmissions, $16,627 vs $29,872, p=0.016). The main areas of cost savings were through reducing unnecessary laboratory tests and imaging investigations. Showing nicely that it is not just reducing bed-days that saves money.

Chris Jones, Guildford. @chrisnjones

Enhanced Recovery Pathways in Pancreatic Surgery

Barton JG. Enhanced Recovery Pathways in Pancreatic Surgery. Surg Clin North Am. 2016 Dec;96(6):1301-1312.

What is already known: Mortality in pancreatic surgery has improved dramatically over the past number of years, from 25% in the 1970’s to only 2% in high-volume centres. Morbidity however remains in excess of 40%. The ERAS society has produced guidelines for pancreatic surgery in 2012, which can be found here.

What this paper adds: This is a really good overview of ERAS for pancreatic surgery, with both a literature review and a more detailed look at some of the specific pancreatic elements. These include: pre-operative biliary drainage, use of intra-abdominal drains post-op, somatostatin analogues and different analgesic regimens. The author also gives a detailed day to day run through of his own institutional ERAS programme.

Chris Jones, Guildford.

ERAS for elderly patients undergoing pancreaticoduodenectomy

Partelli S, Crippa S, Castagnani R, Ruffo G, Marmorale C, Franconi AM, De Angelis C, Falconi M. Evaluation of an enhanced recovery protocol after pancreaticoduodenectomy in elderly patients. HPB (Oxford). 2016 Feb;18(2):153-8.

What is already known:

ERAS society guidelines exist for major pancreatic resections (link), and this study aims to study the effects of an ERAS program on elderly patients (>75 years) undergoing pancreaticoduodenectomy, compared to a historical cohort.

What this paper adds:

A retrospective study demonstrating that ERAS is feasible and safe for elderly patients undergoing pancreaticoduodenectomy. In this small study (88 patients, of which 22 patients underwent an ERAS programme and 66 were historical controls) there was no overall difference in postoperative outcomes, but found a reduced length of stay in patients who had no complications (4 versus 8 days).

Adherence to ERAS elements was mixed. Only 9% had their abdominal drains removed early and 32% tolerated starting an oral diet before postoperative day 4. Whilst 95% had epidural analgesia and 90% had early NG tube removal and tolerated early mobilisation.

Chris Jones, Guildford.