Fast-track recovery programme after pancreaticoduodenectomy reduces delayed gastric emptying

Background: Data on enhanced recovery programmes after pancreatic surgery are sparse. This retrospective cohort study, using historical controls, aimed to evaluate the impact of a fast-track programme after pancreaticoduodenectomy (PD). Methods: Between 2004 and 2007, 252 patients undergoing PD were treated by a fast-track programme that included earlier postoperative feeding and mobilization. The patients were compared with an equally sized control group that received a traditional programme from 2000 to 2004. Outcome measures were morbidity, length of stay and readmission rate. Results: The rates of pancreatic fistula and other intra-abdominal complications were similar in the two groups. Delayed gastric emptying (DGE) was significantly reduced in the fast-track group (13.9 versus 24.6 per cent; P = 0.004). The independent effect of the fast-track protocol in reducing DGE was confirmed by the multiple regression analysis (adjusted odds ratio 0.477, P = 0.005). Length of stay was reduced with the fast-track protocol (median 13 versus 15 days; P < 0.001), without increasing the readmission rate (7.1 versus 6.3 per cent; P = 0.865). Conclusion: A fast-track programme after PD improves gastric emptying and reduces postoperative stay.