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 antibiotics for surgical site infection in pancreaticoduodenectomy: does the SCIP-approved regimen provide adequate coverage?
INTRODUCTION The Joint Commission Surgical Care Improvement Project ( SCIP ) includes performance measures aim ed at reducing surgical site infections ( SSI ) . One measure defines approved perioperative antibiotics for general operative procedures . However , there may be a subset of procedures not adequately covered with the use of approved antibiotics . We hypothesized that piperacillin-tazobactam is a more appropriate perioperative antibiotic for pancreaticoduodenectomy ( PD ) . METHODS In collaboration with hospital epidemiology and the Division of Infectious Diseases , we retrospectively review ed records of 34 patients undergoing PD between March and May 2008 who received SCIP-approved perioperative antibiotics and calculated the SSI rate .  After changing our perioperative antibiotic to piperacillin-tazobactam , we prospect ively review ed PDs performed between June 2008 and March 2009 and compared the SSI rates before and after the change . RESULTS For 34 patients from March through May 2008 , the SSI rate for PD was 32.4 per 100 cases . Common organisms from wound cultures were Enterobacter and Enterococcus ( 50.0 % and 41.7 % , respectively ) , and these were cefoxitin resistant . From June 2008 through March 2009 , 106 PDs were performed . During this period , the SSI rate was 6.6 per 100 surgeries , 80 % lower than during March through May 2008 ( relative risk , 0.204 ; 95 % confidence interval [ CI ] , 0.086 - 0.485 ; P = .0004 ) . CONCLUSION Use of piperacillin-tazobactam as a perioperative antibiotic in PD may reduce SSI compared with the use of SCIP-approved antibiotics . Continued evaluation of SCIP performance measures in relationship to patient outcomes is integral to sustained quality improvement
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 .