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

Not Applicable

Completed

Brief Summary: This randomized clinical trial studies accelerated recovery pathway for discharge after surgery in patients with pancreatic cancer. A standardized accelerated recovery pathway may improve outcomes after surgery following complex abdominal operations resulting in a shorter length of stay in patients with pancreatic cancer. It may also help patients to mobilize more quickly and return to the home setting, decrease hospital-acquired infectious complications, and increase potential cost savings. It is not yet known whether an accelerated recovery pathway is better than a standard recovery pathway for discharge following surgery in patients with pancreatic cancer.

Detailed Description: 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.

Recruitment & Eligibility

Inclusion Criteria

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

Arm && Interventions

Group	Intervention	Description
Accelerated 5-Day Pathway	Pancreaticoduodenectomy	Patients follow the Whipple accelerated 5-day pathway following pancreaticoduodenectomy. 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.
Standard 7-Day Pathway	Pancreaticoduodenectomy	Patients follow the standard 7-day pathway following pancreaticoduodenectomy

Primary Outcome Measures

Name	Time	Method
Percentage of Patients Discharged by Post-operative Day 5	Up to post-operative day 5	Two-sided alpha 0.05 will be used to detect a increase in the percentage of patients discharged on post-operative day 5

Secondary Outcome Measures

Name	Time	Method
Post-operative Median Length of Stay	30 days after operation
Readmission Rate	30 days after operation
Cost	30 days after operation	Cost will be assessed by reviewing inpatient hospital charges
Incidence of Post-operative Complications (DGE, Anastomotic Leaks, Intra-abdominal Abscesses, Wound Infection, UTI, Respiratory Compromise, Renal Failure, Etc.)	30 days after operation