Perioperative Care Implementation: Evidence-Based Practice for Patients With Pancreaticoduodenectomy Using the Enhanced Recovery After Surgery Guidelines

Cesar Aviles, DNP, ANP-BC; Marilyn Hockenberry, PhD, RN, PNP-BC, FAAN; Dionisios Vrochides, MD, PhD, FACS, FRCSC; David Iannitti, MD, FACS; Allyson Cochran, MSPH; Kendra Tezber, BSN, RN; Misty Eller, ANP-BC; Janet Desamero, PA-BC


Background: Pancreatic adenocarcinoma is an aggressive cancer that carries a poor prognosis. Pancreaticoduodenectomy (PD) offers the only potential cure, but the associated morbidity is high. The Enhanced Recovery After Surgery (ERAS) evidence-based guidelines for perioperative care for PD can be used to reduce variations in practice.

Objectives: The primary aim was to evaluate the feasibility of the ERAS guidelines for patients undergoing PD. Secondary aims were to assess length of stay (LOS), readmission within 30 days, 30-day mortality, and total surgical complication rates.

Methods: Guideline feasibility was evaluated by percentage completion and compliance to each of the perioperative phases of the guideline. Hospital LOS, 30-day readmission, 30-day mortality, and total surgical complication rates were compared before and after ERAS implementation. 

Findings: The ERAS guidelines were feasible and safely implemented with no change in LOS, readmission, morbidity, and mortality rates.

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