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 .
Intensive Versus Intermediate Glucose Control in Surgical Intensive Care Unit Patients
OBJECTIVE The optimal perioperative blood glucose range to improve surgical site infection ( SSI ) in surgical intensive care unit ( ICU ) patients remains unclear . We sought to determine whether the incidence of SSI is reduced by perioperative intensive insulin therapy ( IT ) . RESEARCH DESIGN AND METHODS Patients were r and omly assigned to receive perioperative intensive IT , with a target blood glucose range of 4.4–6.1 mmol/L , or intermediate IT , with a target blood glucose range of 7.7–10.0 mmol/L in the surgical ICU . We defined the primary end point as the incidence of SSI . RESULTS Study participants were r and omly assigned to glucose control with one of two target ranges : for 225 patients in the intermediate IT group or for 222 patients in the intensive IT group , respectively . No patients in either group became hypoglycemic ( < 4.4 mmol/L ) during their stay in the surgical ICU . In our series , the rate of SSI after hepato-biliary-pancreatic surgery was 6.7 % . Patients in the intensive IT group , compared with the intermediate IT group , had fewer postoperative SSIs ( 9.8 % vs. 4.1 % , P = 0.028 ) and a lower incidence of postoperative pancreatic fistula after pancreatic resection ( P = 0.040 ) . The length of hospitalization required for patients in the intensive IT group was significantly shorter than that in the intermediate IT group ( P = 0.017 ) . CONCLUSIONS We found that intensive IT decreased the incidence of SSI among patients who underwent hepato-biliary-pancreatic surgery : a blood glucose target of 4.4 to 6.1 mmol/L result ed in lower rate of SSI than did a target of 7.7–10.0
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 .