The impact of enhanced recovery after surgery on intravenous infusion volume in the post-pancreaticoduodenectomy patients

Enhanced Recovery After Surgery (ERAS) are recognized for reducing postoperative complications and accelerating recovery in surgical patients. However, the impact of ERAS on intravenous fluid administration volumes following pancreaticoduodenectomy (PD) remains little known. This study aimed to evaluate the association between ERAS and postoperative intravenous infusion volume in PD patients through a retrospective cohort analysis, comparing ERAS-guided management to traditional perioperative care. This single-center retrospective cohort study analyzed 91 patients undergoing PD between January 2018 and June 2023. Patients were stratified into a non-ERAS group ( n =50, treated with traditional care from January 2018 to March 2020) and an ERAS group ( n =41, managed under an ERAS protocol from March 2022 to June 2023). The primary outcome was the daily cumulative intravenous infusion volume during the first 7 postoperative days. Secondary outcomes included electrolyte and metabolic parameters, complications graded by the Clavien-Dindo classification, and a newly introduced recovery metric, “Time to Readiness for Discharge”. No significant differences were found​ in the basic clinical characteristics and comorbidities between the ERAS and Non-ERAS groups (Table 2). The daily intravenous infusion volumes were significantly lower in the ERAS group on each of the first 7 postoperative days (all p <0.01). There were no significant intergroup differences in serum electrolytes, albumin, or lipid levels during this period. While the distribution of complication severity by Clavien-Dindo grade did not differ, the incidence of pulmonary infection (7.3% vs. 24%, p =0.033) and urinary infection (2.4% vs. 16%, p =0.031), and delayed gastric emptying (4.9% vs. 20%, p =0.034) was significantly lower in the ERAS group. Crucially, the “Time to Readiness for Discharge” was significantly shorter in the ERAS group (12.9 ± 4.2 vs. 14.9 ± 4.7 days, p =0.039). Implementation of an ERAS pathway in PD patients significantly reduces postoperative intravenous fluid administration, lowers infectious complications and shortens time to readiness for discharge, thereby accelerating postoperative recovery.