INTRODUCTION With the advancement in surgical expertise at high-volume centers and advances in perioperative management, pancreaticoduodenectomy is becoming safer and remains the gold standard for treating periampullary pathologies. We describe our experience in optimizing perioperative management in order to avoid admission to the intensive care unit and improve outcomes. METHOD Retrospective data were collected on 370 surgical patients who underwent a pancreaticoduodenectomy between the years 1994 and 2016. RESULTS Of the 370 patients, 200 operated between 2009 and 2016 did not require intensive care admission, blood transfusion, or central line insertion. The results were compared between different time intervals: before the year 1998, between the years 1998 and 2008, and between the years 2009 and 2016. The median blood loss dropped from 800 to 400 to 300 mL, respectively. The median operative time also dropped from 360 to 335 to 215 min, respectively. In addition, the median length of hospital stay decreased from 25 to 16 to 7 days, respectively. CONCLUSION With the centralization of pancreaticoduodenectomy in high-volume centers and with specialized surgeons performing the surgery, there is a significant decrease in the onset of postoperative complications with a lesser need for blood transfusions and, subsequently, better recovery of patients without the need for intensive care unit admission.

中文翻译：

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胰十二指肠切除术的围手术期管理：避免入住重症监护病房。

引言随着高容量中心外科专业技术的进步和围手术期管理的进步，胰十二指肠切除术变得越来越安全，并且仍然是治疗壶腹周围病变的金标准。我们描述了我们在优化围手术期管理以避免进入重症监护病房并改善结果方面的经验。方法 收集 1994 年至 2016 年间接受胰十二指肠切除术的 370 名手术患者的回顾性数据。结果 370 名患者中，200 名在 2009 年至 2016 年间接受了重症监护、输血或中心线插入。结果在不同时间间隔之间进行了比较：1998 年之前、1998 年和 2008 年之间以及 2009 年和 2016 年之间。中位失血量分别从 800 到 400 到 300 毫升下降。中位手术时间也分别从 360 分钟下降到 335 分钟和 215 分钟。此外，住院时间中位数分别从 25 天减少到 16 天和 7 天。结护理单位入院。