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 .
Intraoperative Fluid Resuscitation Strategies in Pancreatectomy: Results from 38 Hospitals in Michigan
Abstract Background Fluid administration practice s may affect complication rates in some abdominal surgeries , but effects in patients undergoing pancreatectomy are not understood well . We sought to determine whether amount of intraoperative fluid administered to patients undergoing pancreatectomy is associated with postoperative complication rates and to determine whether hospitals vary in their fluid administration practice s. Methods Data for 504 patients undergoing pancreatectomy at 38 hospitals between 2012 and 2015 were evaluated . The main exposure was intraoperative fluid administration ( ≤10 , 10–15 , > 15 mL/kg/h ) . Mortality , complications , and length of stay were the main outcomes of interest . Patient-level associations between exposure and outcome were tested , with adjustment for potentially confounding patient and surgical factors , using r and om intercept , mixed-effects linear or logistic regression models . Hospitals were then categorized as having a restrictive , intermediate , or liberal resuscitation practice , and adjusted outcomes were compared . Results A total of 167 ( 33.1 % ) , 185 ( 36.7 % ) and 152 ( 30.2 % ) patients received restrictive , intermediate , or liberal fluid administration , respectively . Hospitals with more restrictive practice s had significantly lower adjusted 30-day mortality than those with more liberal practice s ( 2.7 vs. 6.6 % ; P < 0.001 ) . Hospitals with more restrictive practice s had the lowest rates of severe ( Grade 2 and 3 ) complications ( 15.4 % restrictive vs. 25.3 % intermediate vs. 44.3 % liberal ; P < 0.001 ) . More restrictive hospitals had decreased adjusted mean length of stay ( 9.5 days vs. 12.7 days intermediate vs. 11.6 days liberal ; P < 0.001 ) . Conclusions More restrictive intraoperative resuscitation practice s in pancreatectomy are associated with decreased hospital-level mortality , severe complications , and length of stay
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 .