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 .
Hypoglycemia and risk of death in critically ill patients.
BACKGROUND Whether hypoglycemia leads to death in critically ill patients is unclear . METHODS We examined the associations between moderate and severe hypoglycemia ( blood glucose , 41 to 70 mg per deciliter [ 2.3 to 3.9 mmol per liter ] and ≤40 mg per deciliter [ 2.2 mmol per liter ] , respectively ) and death among 6026 critically ill patients in intensive care units ( ICUs ) . Patients were r and omly assigned to intensive or conventional glucose control . We used Cox regression analysis with adjustment for treatment assignment and for baseline and postr and omization covariates . RESULTS Follow-up data were available for 6026 patients : 2714 ( 45.0 % ) had moderate hypoglycemia , 2237 of whom ( 82.4 % ) were in the intensive-control group ( i.e. , 74.2 % of the 3013 patients in the group ) , and 223 patients ( 3.7 % ) had severe hypoglycemia , 208 of whom ( 93.3 % ) were in the intensive-control group ( i.e. , 6.9 % of the patients in this group ) . Of the 3089 patients who did not have hypoglycemia , 726 ( 23.5 % ) died , as compared with 774 of the 2714 with moderate hypoglycemia ( 28.5 % ) and 79 of the 223 with severe hypoglycemia ( 35.4 % ) . The adjusted hazard ratios for death among patients with moderate or severe hypoglycemia , as compared with those without hypoglycemia , were 1.41 ( 95 % confidence interval [ CI ] , 1.21 to 1.62 ; P<0.001 ) and 2.10 ( 95 % CI , 1.59 to 2.77 ; P<0.001 ) , respectively . The association with death was increased among patients who had moderate hypoglycemia on more than 1 day ( > 1 day vs. 1 day , P=0.01 ) , those who died from distributive ( vasodilated ) shock ( P<0.001 ) , and those who had severe hypoglycemia in the absence of insulin treatment ( hazard ratio , 3.84 ; 95 % CI , 2.37 to 6.23 ; P<0.001 ) . CONCLUSIONS In critically ill patients  , intensive glucose control leads to moderate and severe hypoglycemia , both of which are associated with an increased risk of death . The association exhibits a dose-response relationship and is strongest for death from distributive shock . However , these data can not prove a causal relationship . ( Funded by the Australian National Health and Medical Research Council and others ; NICE-SUGAR Clinical Trials.gov number , NCT00220987 . )
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 .