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 .
Impact of fluid resuscitation on major adverse events following pancreaticoduodenectomy.
BACKGROUND Pancreaticoduodenectomy remains a major undertaking with substantial perioperative morbidity and mortality . Previous studies in the colorectal population have noted a correlation between excessive postoperative fluid resuscitation and anastomotic complications . This study sought to assess the relationship between perioperative fluid management and clinical outcomes in patients undergoing pancreaticoduodenectomy . METHODS Data from a single institution , prospect i ve data base over a 10-year period ( 2002 to 2012 ) were review ed . Patients were compared for perioperative fluid balance and postoperative outcomes . Multivariable analysis was performed to assess the relationship between perioperative fluid administration and incidence of major adverse events . RESULTS Higher positive fluid balance on postoperative day 0 , postoperative day 1 , and postoperative day 2 was associated with increased incidence of major adverse events , increased postoperative intensive care unit admission , and longer hospital stay . Higher positive fluid balance on postoperative day 0 was most strongly associated with postoperative morbidity ( odds ratio 1.39 , confidence interval 1.16 to 1.66 , P = .0003 ) . Fluid balance on postoperative day 3 was not associated with adverse events . CONCLUSIONS Increased early perioperative fluid resuscitation  is associated with major adverse events in patients undergoing pancreaticoduodenectomy . More restrictive fluid administration may improve postoperative outcomes ; further prospect i ve clinical trials focused on fluid resuscitation and goal -directed therapy are needed
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 .