Accelerated Recovery Pathway for Discharge After Surgery in Patients With Pancreatic Cancer

PRIMARY OBJECTIVES:

I. The use of an accelerated pathway will result in a shorter postoperative hospital length of stay for patients undergoing pancreaticoduodenectomy (PD) without an increase in perioperative complications or readmission rates.

SECONDARY OBJECTIVES:

I. The investigators anticipate lower cost, lower readmission rate, similar rate of post-operative complications (delayed gastric emptying [DGE], anastomotic leaks, intra-abdominal abscesses, wound infection, urinary tract infection [UTI], respiratory compromise, renal failure, etc.) in our study group.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients follow the standard 7-day pathway at the end of surgery.

ARM II: Patients follow the Whipple accelerated 5-day pathway at the end of surgery. The accelerated pathway includes more rapidly leaving the ICU setting, early mobilization and enhanced physical therapy, multimodal pain control, dietary modifications, and increased and standardized phone contact by a nurse practitioner during the first week following hospital discharge.

After completion of study treatment, patients are followed up periodically.

Inclusion criteria

• Pancreaticoduodenectomy
• Firm gland texture
• Subjects able to provide informed consent

Exclusion criteria

• Preoperative factors:

• Congestive heart failure (CHF)
• End stage renal disease (ESRD)
• Chronic obstructive pulmonary disease (COPD)
• Pregnancy
• Albumin < 3 gm/dL
• Poor preoperative performance status as defined by: timed get up and go (< 15 seconds)
• Patients cannot be homeless or have substance dependence
• Intraoperative factors:

• Estimated blood loss (EBL) > 1 liter
• Failure to extubate at the conclusion of the case
• Operative time > 8 hours
• Need for vascular resection/reconstruction