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Implementing a Program Evaluation of the Enhanced Recovery After Surgery Pathway in Patients Undergoing a Pancreaticoduodenectomy

Year: 2026
Type: dissertation
Study design: Observational Study
Abstract: Background: Pancreaticoduodenectomy (Whipple procedure) is a complex surgical intervention associated with significant metabolic stress and postoperative complications (American Cancer Society, 2024). Partial pancreatic resection disrupts endocrine function through decreased insulin production, impaired glucagon regulation, and islet cell injury (Melloul et al., 2020). Alterations in incretin hormones further impair glucose homeostasis (Longo et al., 2024). Postoperative hyperglycemia is common and exacerbated by the physiologic stress response, contributing to insulin resistance and increased risk of complications such as surgical site infection and delayed wound healing (Téoule et al., 2019; Ellwanger et al., 2025). Enhanced Recovery After Surgery (ERAS) pathways aim to standardize perioperative care, with glycemic management as a key component.Purpose: To evaluate postoperative glycemic control within an established ERAS pathway among patients undergoing pancreaticoduodenectomy.Methods: A retrospective program evaluation was conducted using chart review of adult patients undergoing pancreaticoduodenectomy from January 1, 2020 to December 31, 2025. Process measures included postoperative glucose levels on postoperative days 0–2 and incidence of hyperglycemia (>150 mg/dL). Outcome measures included surgical site infection, pancreatic fistula, length of stay, 30-day mortality, and readmission. Balancing measures included insulin utilization, endocrinology consultation, intraoperative steroid use, postoperative unit placement, and surgeon variability.Results: Ninety patients were included. Mean postoperative glucose was approximately 160 mg/dL, with hyperglycemia (>150 mg/dL) observed in 60–75% of patients and severe hyperglycemia (>250 mg/dL) in 9–12%. Surgical site infection rates ranged from 0–8%, and pancreatic fistula occurred in 4% of patients. A weak but statistically significant correlation was found between mean postoperative glucose and ICU length of stay (r = 0.28, p = 0.04).Conclusion: ERAS glycemic management practices were implemented consistently and associated with acceptable outcomes. Ongoing emphasis on standardized glycemic monitoring and multidisciplinary adherence may further optimize recovery and reduce complications.
DOI: 10.17615/4p6d-f384
Language: English
Subfield: Surgery
Field: Medicine
Open Access status: green
OpenAlex ID: W7162794553
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