Background: Factors affecting length of hospital stay after uncomplicated pancreaticoduodenectomy (PD) have not been reported. Fast track recovery program(s) (FTRP) are increasingly utilised to expedite patient recovery, but their utility following uncomplicated PD is uncertain. We hypothesized that patients undergoing uncomplicated PD treated by FTRP would have a shorter length of hospital stay compared to those managed by a standard program.
Methods: The records of patients without complications following PD managed by fast track or standard protocols, 2005 and 2011 were identified. Patient demographics, peri-operative details and clinicopathological features were compared to determine prognostic predictors for length of hospital stay.
Results: Forty-one patients treated by PD had no medical or surgical complications during this period. Of these patients, 20 underwent FTRP compared to 21 who underwent standard care. Patients in the standard group were more likely to have a feeding jejunostomy tube, pylorus preserving procedure and a nasogastric tube in place longer than 24 hours post-operatively (p<0.05). The median post-operative length of stay was shorter in the FTRP group (8 (range: 7-16) days versus 14 (range: 8-29) days; p<0.001). There were three readmissions in the FTRP program related to abdominal pain and none in the standard group. The overall length of stay, accounting for readmissions, still remained significantly shorter in the FTRP group (9 days versus 14 days; p<0.001). There were no significant differences in discharge destination between groups. On univariate analysis, the factors associated with discharge by day 8 post surgery were FTRP (Odds ratio (OR) 37 (4.1-338); p<0.001), a negative fluid balance on post-operative day 2 (OR 3.8 (1.0-14.9); p=0.049) and absence of a feeding jejunostomy (O.R 1.6 (1.2-2.1); p=0.017). On multivariate analysis, the only factor independently associated with post-operative discharge by day 8 was FTRP (O.R 37 (4.1-338); p=0.001).
Conclusion: FTRP achieved significantly shorter length of stay following uncomplicated PD.