Outcome after implementation of a clinical pathway for pancreaticoduodenectomy in a low volume centre

Introduction
To study whether the implementation of a clinical pathway including some enhanced recovery after surgery (ERAS) items for pancreaticoduodenectomy (PD) in a low volume centre for pancreatic surgery was safe.

Material and methods
Patients undergoing elective PD within a clinical pathway between 1 October 2013 and 30 September 2019 were considered for the study and the outcome was compared between the first and second period of the study. The primary endpoint was the achievement of postoperative key targets of the protocol. Secondary endpoints were complications, mortality and readmissions within 90 days postoperatively, and postoperative hospital stay.

Results
Forty-five patients could be analysed. The two groups were balanced for demographic, clinical and histological variables. In the second period more patients achieved key targets: nasogastric tube removal at postoperative day (PoD) 2, oral fluids at PoD 3, drain removal at PoD 5 and hospital discharge at PoD 9. The rates of postoperative complications, mortality and readmissions were not significantly different between the two groups and were similar to data reported for high volume centres.

Conclusions
Our results show that the implementation of a clinical pathway following PD and including some ERAS items was feasible and safe in a low volume centre for pancreatic surgery.