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 .
Circulating-water garment or the combination of a circulating-water mattress and forced-air cover to maintain core temperature during major upper-abdominal surgery.
BACKGROUND A recent heat-balance study in volunteers suggested that greater efficacy of circulating-water garments ( CWGs ) results largely from increased heat transfer across the posterior skin surface since heat transfer across the anterior skin surface was similar with circulating-water and forced-air . We thus tested the hypothesis that the combination of a circulating-water mattress ( CWM ) and forced-air warming prevents core temperature reduction during major abdominal surgery no worse than a CWG does . METHODS Fifty adult patients aged between 18 and 85 yr old , undergoing major abdominal surgery , were r and omly assigned to intraoperative warming with a combination of forced-air and a CWM or with a CWG ( Allon ThermoWrap ) . Core temperature was measured in the distal oesophagus . Non-inferiority of the CWM to the CWG on change from baseline to median intraoperative temperature was assessed using a one-tailed Student 's t-test with an equivalency buffer of -0.5 ° C . RESULTS Data analysis was restricted to 16 CWG and 20 CWM patients who completed the protocol . Core temperature increased in both groups during the initial hours of surgery . We had sufficient evidence ( P=0.001 ) , to conclude that the combination of a CWM and forced-air warming was non-inferior to a CWG in preventing temperature reduction , with mean ( 95 % CI ) difference in the temperature change between the CWM and the CWG groups ( CWM-CWG ) of 0.46 ° C ( -0.09 ° C , 1.00 ° C ) . CONCLUSIONS The combination of a CWM and forced-air warming is significantly non-inferior in maintaining intraoperative core temperature than a CWG . TRIAL REGISTRY This trial has been registered at clinical trials.gov , identifier : NCT 00651898
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 .