Comparative evaluation of immediate outcomes of ERAS-associated and traditional postoperative management after pancreatic resection

Objective: To compare immediate outcomes of ERAS-associated and traditional postoperative management after pancreatic resection.

Material and Methods: This non-randomized comparative retrospective-prospective study with historical control included 63 patients who underwent pancreatic resection. The ERAS group comprised 25 patients managed with an adapted enhanced recovery protocol, whereas 38 patients received conventional postoperative care. Quantitative data are presented as Me [Q1-Q3] and categorical data as n (%). Methods included the Mann-Whitney U test, Fisher’s exact test, relative risk, odds ratio, and 95% confidence intervals.

Results: Overall postoperative morbidity was 24.0% in the ERAS group versus 60.5% in the control group (p=0.005). ERAS-associated management reduced the relative risk of complications to 0.40 (95% CI 0.19-0.83) and the odds ratio to 0.21 (95% CI 0.07-0.63). In the ERAS group, bowel activity recovered earlier - 2.0 [1.4-2.3] versus 3.5 [2.7-4.0] days (p<0.001), first stool occurred earlier - 2.6 [2.0-3.3] versus 4.2 [3.2-4.9] days (p<0.001), oral intake started earlier - 1.3 [0.8-1.6] versus 3.2 [2.8-3.8] days (p<0.001), ICU stay was shorter - 16 [11-22] versus 24 [14-34] hours (p=0.002), and postoperative hospital stay decreased - 13 [11-15] versus 16 [13-20] days (p=0.001). Pain intensity, opioid use, and nutritional decline were also lower in the ERAS group.

Conclusions: ERAS-associated postoperative management after pancreatic resection was linked to a more favorable early postoperative course, lower overall morbidity, and shorter hospitalization compared with conventional care.

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