P0038 - Impact of ERAS Protocol on Post-Operative Outcomes of Pancreaticoduodenectomy: An Initial Experience in a Resource-Limited Setting

Muhammad Ahmad, MBBS¹, Malik Khan, MD², Zia Ullah, MBBS³, Nouman Shafique, MD⁴, Nihal I. Khan, MD⁴, Salman Khan, MD⁵, Abdul Moeez, MBBS⁶, Amir hassan, MBBS^7
1Khyber Medical College, Peshawar, North-West Frontier, Pakistan; ²Yale University School of Medicine, New York, NY; ³Khyber Teaching Hospital, Peshawar, North-West Frontier, Pakistan; ⁴AdventHealth Medical Group, AdventHealth, Orlando, FL; ⁵Staten Island University Hospital, Northwell Health, New York, NY; ⁶Khyber Medical College, Mardan, North-West Frontier, Pakistan; ⁷Bronglais Hospital, Aberystwyth, England, United Kingdom

Introduction: Pancreaticoduodenectomy (PD) is associated with significant morbidity. Enhanced Recovery after Surgery (ERAS) is a multi-faceted and multidisciplinary approach towards improving postoperative outcomes and has been shown to reduce hospital stay and morbidity and accelerate recovery. Our study focuses on the applicability of ERAS in a tertiary care center in a developing country and its impact on the outcome profiles of patients undergoing pancreaticoduodenectomy.

Methods: This is a prospective cohort study at Khyber Teaching Hospital, Pakistan. Initially, 30 patients were included in the study; after informed consent, they were randomly assigned to the ERAS and conventional cohorts. Patients undergoing pancreatic surgery were included, with the exception of those who had laparoscopic surgeries or had an American Society of Anesthesiology score of 4. All surgical procedures were performed by a single experienced surgeon and his team. Postoperative complications were defined according to Clavien-Dindo criteria and the International Study Group on Pancreatic Surgery. Mortality was defined as any death occurring within 30 days of surgery, and readmission was defined as admission to the hospital within one month of discharge.

Results: The mean age of patients in the ERAS group was 52.0 ± 8.8 years, while that of the conventional group was 53.5 ± 8.8 years. The majority of patients (93.3%) in both groups had an ASA score of ≤2. There were no differences in the type of surgery or intraoperative variables. Postoperative complications were similar in both groups (p = 0.715); however, the incidence of delayed gastric emptying was lower in the ERAS group 1 (6.7%) compared to the conventional group 5 (33.3%), though statistically insignificant (p = 0.068). The length of hospital stay (LOS) was 7.87 ± 0.83 days in the ERAS group and 11.87 ± 1.68 days in the conventional group (p< 0.001).

Discussion: This study demonstrates that the ERAS protocol can be safely and effectively implemented in a developing country as it improves patient outcomes and produces a substantial decrease in the length of hospital stay. Further studies with larger sample sizes are required to validate these findings and guide clinical decision-making.


Disclosures:


Muhammad Ahmad, MBBS¹, Malik Khan, MD², Zia Ullah, MBBS³, Nouman Shafique, MD⁴, Nihal I. Khan, MD⁴, Salman Khan, MD⁵, Abdul Moeez, MBBS⁶, Amir hassan, MBBS⁷. P0038 - Impact of ERAS Protocol on Post-Operative Outcomes of Pancreaticoduodenectomy: An Initial Experience in a Resource-Limited Setting, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.