Enhanced Recovery Deviation and Failure After Pancreaticoduodenectomy: Causative  Factors and Impact.

Enhanced Recovery Deviation and Failure After Pancreaticoduodenectomy: Causative  Factors and Impact.

Tankel J et al. Enhanced Recovery Deviation and Failure After Pancreaticoduodenectomy: Causative
Factors and Impact. Surg Res. 2020 Jan;245:569-576.

What is already known:

ERAS for pancreaticoduodenectomy has been around for a while. The ERAS society first published guidelines in 2012 and then updated in 2019 [they can be found here]. However, these procedures still have a high morbidity and despite the best efforts of both clinicians and patients, there will be some patients who will either deviate from the ERAS protocol or fail ERAS’ key goals. The key is to predict which ones.

What this paper adds:

Interestingly there was no discernible relationship between
ERAS protocol deviation and failure. There was also no relationship noted between protocol deviation and serious complications or pancreatic fistula. Univariate and multivariate analyses identified variables associated with protocol deviation and failure. On univariate analysis: protocol deviation was associated with male gender, prolonged surgery time (>270 min) and prolonged Length of Stay. On multivariate analysis only prolonged LoS remained significant. Perhaps this is obvious? It stands to reason that if there are deviations from protocol then this would be associated with prolonged LoS. It suggests that perhaps deviation does not alter the course of those destined to ultimately fail to achieve the ERAS protocol goals. The next step is to accurately predict complications. The holy grail?

Chris Jones, Guildford.