Outcomes After ERAS Pathway in Open and Robotic Pancreatic Surgery: A Retrospective Cohort Study

Abstract

Introduction: Enhanced recovery after surgery (ERAS) pathways improve outcomes for patients following open pancreaticoduodenectomy (PD). However, the impact of ERAS protocols following robotic pancreas surgery is less understood. This study aims to compare patient outcomes in open and robotic pancreas surgery, including PD and distal pancreatectomy (DP), following implementation of an ERAS pathway.

Methods: This single-center retrospective cohort study was conducted from August 2018 to December 2022 and analyzed patients who underwent pancreatic surgery. Baseline characteristics, perioperative and postoperative outcomes, including postoperative morphine utilization, were compared between ERAS and non-ERAS cohorts. Univariate and multivariable analyses were performed.

Results: Of the 220 patients included in the study, average age was 68 y, 50.5% were female, 64.5% underwent PD, and a robotic approach was utilized in 68.6% of patients. The ERAS cohort required less postoperative opioids (58 versus 148 morphine milligram equivalents, P < 0.0001), and had lower pain scores on postoperative day 0 (6 versus 8, P < 0.0001) compared to the non-ERAS cohort. On multivariable analyses, the ERAS cohort was less likely to experience a complication overall (P < 0.0001), and in the PD (P = 0.0004), DP (P = 0.0003), and robotic subgroups (P = 0.0002).

Conclusions: The utilization of an ERAS pathway following pancreatic surgery is associated with reduced postoperative opioid use, lower pain scores, and fewer complications, supporting its safety and feasibility for PD, DP, and use in a robotic approach.

Keywords: Distal pancreatectomy; Enhanced recovery after surgery (ERAS); Minimally invasive surgery; Pancreatic surgery; Pancreaticoduodenectomy; Perioperative care; Robotic pancreas surgery.