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 .
Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization
AIM To characterize incidence and risk factors for delayed gastric emptying ( DGE ) following pancreaticoduodenectomy  and examine its implication s on healthcare utilization . METHODS A prospect ively-maintained data base was review ed . DGE was classified using International Study Group of Pancreatic Surgery criteria . Patients who developed DGE and those who did not were compared . RESULTS Two hundred and seventy-six patients underwent pancreaticoduodenectomy ( PD ) ( > 80 % pylorus-preserving , antecolic-reconstruction ) .  DGE developed in 49 patients ( 17.8 % ) : 5.1 % grade B , 3.6 % grade C. Demographic , clinical , and operative variables were similar between patients with DGE and those without . DGE patients were more likely to present multiple complications ( 32.6 % vs 4.4 % , ≥ 3 complications , P < 0.001 ) , including postoperative pancreatic fistula ( POPF ) ( 42.9 % vs 18.9 % , P = 0.001 ) and intra-abdominal abscess ( IAA ) ( 16.3 % vs 4.0 % , P = 0.012 ) . Patients with DGE had longer hospital stay ( median , 12 d vs 7 d , P < 0.001 ) and were more likely to require transitional care upon discharge ( 24.5 % vs 6.6 % , P < 0.001 ) . On multivariate analysis , predictors for DGE included POPF [ OR = 3.39 ( 1.35 - 8.52 ) , P = 0.009 ] and IAA [ OR = 1.51 ( 1.03 - 2.22 ) , P = 0.035 ] . CONCLUSION Although DGE occurred in < 20 % of patients after PD , it was associated with increased healthcare utilization . Patients with POPF and IAA were at risk for DGE . Anticipating DGE can help individualize care and allocate re sources to high-risk patients
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 .