A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .
Evidence-based analysis of risk factors for postoperative nausea and vomiting.
BACKGROUND /st > In assessing a patient 's risk for postoperative nausea and vomiting ( PONV ) , it is important to know which risk factors are independent predictors , and which factors are not relevant for predicting PONV . METHODS /st > We conducted a systematic review of prospect i ve studies ( n>500 patients ) that applied multivariate logistic regression analyses to identify independent predictors of PONV . Odds ratios ( ORs ) of individual studies were pooled to calculate a more accurate overall point estimate for each predictor . RESULTS /st > We identified 22 studies ( n=95 154 ) . Female gender was the strongest patient-specific predictor ( OR 2.57 , 95 % confidence interval 2.32 - 2.84 ) , followed by the history of PONV/motion sickness ( 2.09 , 1.90 - 2.29 ) , non-smoking status ( 1.82 , 1.68 - 1.98 ) , history of motion sickness ( 1.77 , 1.55 - 2.04 ) , and age ( 0.88 per decade , 0.84 - 0.92 ) . The use of volatile anaesthetics was the strongest anaesthesia-related predictor ( 1.82 , 1.56 - 2.13 ) , followed by the duration of anaesthesia ( 1.46 h(-1 ) , 1.30 - 1.63 ) , postoperative opioid use ( 1.39 , 1.20 - 1.60 ) , and nitrous oxide ( 1.45 , 1.06 - 1.98 ) . Evidence for the effect of type of surgery is conflicting as reference groups differed widely and funnel plots suggested significant publication bias . Evidence for other potential risk factors was insufficient ( e.g. preoperative fasting ) or negative ( e.g. menstrual cycle ) . CONCLUSIONS /st > The most reliable independent predictors of PONV were female gender , history of PONV or motion sickness , non-smoker , younger age , duration of anaesthesia with volatile anaesthetics , and postoperative opioids . There is no or insufficient evidence for a number of commonly held factors , such as preoperative fasting , menstrual cycle , and surgery type , and using these factors may be counterproductive in assessing a patient 's risk for PONV
A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .