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 .
Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial.
OBJECTIVE To assess the relationship between body temperature and cardiac morbidity during the perioperative period . DESIGN R and omized controlled trial comparing routine thermal care ( hypothermic group ) to additional supplemental warming care ( normothermic group ) . SETTING Operating rooms and surgical intensive care unit at an academic medical center . SUBJECTS Three hundred patients undergoing abdominal , thoracic , or vascular surgical procedures who either had documented coronary artery disease or were at high risk for coronary disease . OUTCOME MEASURE The relative risk of a morbid cardiac event ( unstable angina/ischemia , cardiac arrest , or myocardial infa rct ion ) according to thermal treatment . Cardiac outcomes were assessed in a double-blind fashion . RESULTS Mean core temperature after surgery was lower in the hypothermic group ( 35.4+/-0.1 degrees C ) than in the normothermic group ( 36.7+/-0.1 degrees C ) ( P<.001 ) and remained lower during the early postoperative period . Perioperative morbid cardiac events occurred less frequently in the normothermic group than in the hypothermic group ( 1.4 % vs 6.3 % ; P=.02 ) . Hypothermia was an independent predictor of morbid cardiac events by multivariate analysis ( relative risk , 2.2 ; 95 % confidence interval , 1.1 - 4.7 ; P=.04 ) , indicating a 55 % reduction in risk when normothermia was maintained . Postoperative ventricular tachycardia also occurred less frequently in the normothermic group than in the hypothermic group ( 2.4 % vs 7.9 % ; P=.04 ) . CONCLUSION In patients with cardiac risk factors who are undergoing noncardiac surgery , the perioperative maintenance of normothermia is associated with a reduced incidence of morbid cardiac events and ventricular tachycardia
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 .