Impact of Enhanced Recovery after Surgery protocol on immediate surgical outcome in elderly patients undergoing pancreaticoduodenectomy

  • Lileswar KamanEmail author
  • Karikal Chakarbathi
  • Ashish Gupta
  • Divya Dahiya
  • Kaptan Singh
  • Krishna Ramavath
  • Arunanshu Behera
  • Kamal Kajal
Original Article


The numbers of patients undergoing pancreaticoduodenectomy are increasing and considerable percentage is elderly patients. Pancreaticoduodenectomy is a major and complicated surgery. The morbidity and mortality following pancreaticoduodenectomy have significantly reduced in recent times; it still remains unclear in elderly patients. Applications of Enhanced Recovery after Surgery protocol have contributed for this better outcome. In this retrospective study, patients who underwent pancreaticoduodenectomy with Enhanced Recovery after Surgery protocol were included and divided into two groups (< 60 years vs ≥ 60 years). The “elderly patients” (≥ 60 years) were defined based on the WHO definition for Indian subcontinent. Outcomes were analyzed in terms of postoperative morbidity, mortality and length of hospital stay. Total 103 patients underwent pancreaticoduodenectomy during the study period (January 2012–December 2017). The mean age was 56.6 ± 10.32 years. Fifty-six (54.37%) patients were aged < 60 years (young group) and 47 (45.63%) patients were aged ≥ 60 years (elderly group). There was no difference between the groups in terms of age, gender, co-morbidity, preoperative drainage and diagnosis. There was no significant difference in the morbidity and mortality (p > 0.05). Delayed gastric emptying was the most common complication which was 25.24% (21% vs 23.41%). Pancreatic fistula rate was 13.59% (8.9% vs 12.76%) and hemorrhage was 4.85% (5.4% vs 4.3%). Mortality was 4.85%. Postoperative hospital stay was comparable (14.7 days vs 15.3 days) (p = 0.164). Pancreaticoduodenectomy is a safe surgical procedure in elderly patients in comparison to young patients. Application of Enhanced Recovery after Surgery protocol can improve the outcome further.


ERAS protocol Elderly patient Pancreaticoduodenectomy Morbidity and mortality 


Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Research involving human participants and/or animals

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the study patients.


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Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  • Lileswar Kaman
    • 1
    Email author
  • Karikal Chakarbathi
    • 1
  • Ashish Gupta
    • 1
  • Divya Dahiya
    • 1
  • Kaptan Singh
    • 1
  • Krishna Ramavath
    • 1
  • Arunanshu Behera
    • 1
  • Kamal Kajal
    • 2
  1. 1.Department of General SurgeryPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of AnaesthesiaPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

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