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 .
A Prognostic Score to Predict Major Complications After Pancreaticoduodenectomy
Objective : To develop and vali date a simple prognostic score to predict major postoperative complications after  pancreaticoduodenectomy ( PD ) .  Background : PD still carries a high rate of severe postoperative complications . No specific score is currently available to stratify the patient 's risk of major morbidity . Methods : Between 2002 and 2010 , preoperative , intraoperative , and outcome data from 700 consecutive patients undergoing PD in our institution were prospect ively collected in an electronic data base . Major complications were defined as levels III to V of Clavien-Dindo classification . On the basis of a multivariate regression model , the score was developed using a r and om two-thirds of the population ( n = 469 ) and was vali date d on the remaining 231 patients . Results : Major complication rate was 16.7 % ( 117/700 ) . Significant predictors included in the scoring system were : pancreas texture , pancreatic duct diameter , operative blood loss , and ASA score . The mean risk of developing major postoperative complications was 7 % in patients with score 0 to 3 , 13 % in patients with score 4 to 7 , 23 % in patients with score 8 to 11 , and 36 % in patients with score 12 to 15 . In the validation population , the predicted risk of major complications was 15.2 % versus a 16.9 % observed risk ( C-statistic index = 0.743 ) . Conclusion : This new score may accurately predict a patient 's postoperative outcome . Early identification of high-risk patients could help the surgeon to adopt intraoperative and postoperative strategies tailored on individual basis
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 .