{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:07:46Z","timestamp":1785434866414,"version":"3.56.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pancreaticoduodenectomy (PD) is often a morbid procedure with a prolonged recovery time. Enhanced recovery after surgery (ERAS) protocols have been shown to improve outcomes at high-volume hepatopancreaticobiliary (HPB) centers, but data on their implementation and reproducibility in moderate-volume institutions remain limited. In 2018, we implemented a standardized ERAS protocol for patients undergoing PD at a Commission on Cancer (CoC)-accredited, moderate-volume teaching hospital with a mean annual PD volume of 30 cases. Components of this pathway included a nurse-led preoperative educational session, nutritional optimization, multimodal pain control, incentive spirometer use, and early ambulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 200 patients who underwent PD between January 2015 and December 2022 compared ICU length of stay, overall hospital length of stay, and discharge disposition before and after the implementation of the standardized ERAS protocol. Patient demographics and clinical characteristics were similar between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Enhanced recovery after surgery implementation was associated with significant reductions in ICU stay (mean 3.13\u00a0days vs 0.82\u00a0days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001), reductions in hospital length of stay (mean 15.37 vs 11.21\u00a0days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0012), and increases in favorable discharge disposition to home (73.1% vs 83.1%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .044). No remarkable differences were noted in readmission rates or death within 30\u00a0days after surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Implementation of a standardized ERAS program for PD can be successfully achieved at a moderate-volume institution with results comparable to those reported from specialized high-volume HPB centers. These findings support the broader applicability of ERAS for PD beyond major academic referral centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261472837","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:04:26Z","timestamp":1785222266000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementing ERAS Beyond High-Volume HPB Centers: Reduced ICU Utilization and Length of Stay After Pancreaticoduodenectomy"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3147-6251","authenticated-orcid":false,"given":"Sahithi P.","family":"Puvvala","sequence":"first","affiliation":[{"name":", Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Mattern","sequence":"additional","affiliation":[{"name":"Baylor Scott and White"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Missy","family":"Angel","sequence":"additional","affiliation":[{"name":"Baylor Scott and White"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Bower","sequence":"additional","affiliation":[{"name":"Baylor Scott and White"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey A.","family":"Milan","sequence":"additional","affiliation":[{"name":"Baylor Scott and White"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"2","key":"e_1_3_3_2_2","first-page":"196","article-title":"Systematic review of enhanced recovery programmes in pancreatic surgery","volume":"100","author":"Coolsen MME","year":"2013","unstructured":"Coolsen MME, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CHC. Systematic review of enhanced recovery programmes in pancreatic surgery. Br J Surg. 2013;100(2):196-208.","journal-title":"Br J Surg"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2017.06.040"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003835"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2018-213020"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10081634"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1676474"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2018.07.011"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-018-4844-y"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-019-05252-z"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2018.01.002"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-022-04508-x"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znab436"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.19558"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v17.i7.107085"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2018.11.043"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31564"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1159\/000539785"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/AS9.0000000000000501"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-020-05499-x"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S400030"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261472837","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261472837","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261472837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:47:07Z","timestamp":1785433627000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261472837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":20,"alternative-id":["10.1177\/00031348261472837"],"URL":"https:\/\/doi.org\/10.1177\/00031348261472837","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"article-number":"00031348261472837"}}