Global Perceptions on ERAS^® in Pancreatoduodenectomy

Background: Uptake of ERAS^® pathways for pancreatic surgery have been slow and impacted by low compliance. Objective: To explore global awareness, perceptions and practice of ERAS^® peri-pancreatoduodenectomy (PD). Methods: A structured, web-based survey (EPSILON) was administered through the ERAS^® society and IHPBA membership. Results: The 140 respondents included predominantly males (86.4%), from Europe (45%), practicing surgery (95%) at academic/teaching hospitals (63.6%) over a period of 10–20 years (38.6%). Most respondents identified themselves as general surgeons (68.6%) with 40.7% reporting an annual PD volume of 20–50 cases, practicing post-PD clinical pathways (37.9%), with 31.4% of respondents auditing their outcomes annually. Reduced medical complications, cost and hospital length of stay, and improved patient satisfaction were perceived benefits of compliance to enhancing-recovery. Multidisciplinary co-ordination was considered the most important factor in the implementation and sustainability of peri-PD ERAS^® pathways, while reluctance to change among health care practitioners, difficulties in data collection and audit, lack of administrative support, and recruitment of an ERAS^® dedicated nurse were reported to be important barriers. Conclusions: The EPSILON survey highlighted global clinician perceptions regarding the benefits of compliance to peri-PD ERAS^®, the importance of individual components, perceived facilitators and barriers, to the implementation and sustainability of these pathways.