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 .
Ensuring Early Mobilization Within an Enhanced Recovery Program for Colorectal Surgery: A Randomized Controlled Trial
Objective : To estimate the extent to which the addition of staff-directed facilitation of early mobilization to an Enhanced Recovery Program ( ERP ) impacts recovery after colorectal surgery , compared with usual care . Summary Background Data : Early mobilization is considered an important component of ERPs but , despite guidelines recommendations , adherence remains quite low . The value of dedicating specific re sources ( eg , staff time ) to increase early mobilization is unknown . Methods : This r and omized trial involved 99 colorectal surgery patients in an established ERP ( median age 63 , 57 % male , 80 % laparoscopic ) r and omized 1:1 to usual care  ( including preoperative education about early mobilization with postoperative daily targets ) or facilitated mobilization [ staff dedicated to assist transfers and walking from postoperative days ( PODs ) 0–3 ] . Primary outcome was the proportion of patients returning to preoperative functional walking capacity ( 6-min walk test ) at 4 weeks after surgery . We also explored the association of the intervention with in-hospital mobilization , time to achieve discharge criteria , time to recover gastrointestinal function , 30-day comprehensive complication index , and patient-reported outcome measures . Results : In the facilitated mobilization group , adherence to mobilization targets was greater on POD0 [ OR 4.7 ( 95 % CI 1.8–11.9 ) ] , POD1 [ OR 6.5 ( 95 % CI 2.3–18.3 ) ] , and POD2 [ OR 3.7 ( 95 % CI 1.2–11.3 ) ] . Step count was at least 2-fold greater on POD1 [ mean difference 843.3 steps ( 95 % CI 219.5–1467.1 ) ] and POD2 [ mean difference 1099.4 steps ( 95 % CI 282.7–1916.1 ) ] There was no between-group difference in recovery of walking capacity at 4 weeks after surgery [ OR 0.77 ( 95 % CI 0.30–1.97 ) ] . Other outcome measures were also not different between groups . Conclusions : In an ERP for colorectal surgery , staff-directed facilitation of early mobilization increased out-of-bed activities during hospital stay but did not improve outcomes . This study does not support the value of allocating additional re sources to ensure early mobilization in ERPs . Trial Registration : Clinical Trials.gov Identifier :
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 .