Risk factors for failure of early recovery from pancreatoduodenectomy despite the use of enhanced recovery after surgery protocols and a physical aging score to predict postoperative risks

Background Enhanced recovery after surgery (ERAS) protocols are beneficial for pancreatoduodenectomy (PD). Our aim was to evaluate risk factors associated with ERAS protocol failure after PD. Methods Clinical variables of 187 patients managed using ERAS protocols between April 2011 and April 2017, including non‐early recovery (non‐ER) patients, with complications or requiring a hospital stay ≥15 days, and early recovery (ER) patients, were compared. A physical aging (PA) score was devised to predict postoperative risks. Results Independent risk factors of complications were a pre‐albumin level ≤18 mg/dl (odds ratio (OR) 2.197; 95% confidence interval (CI) 1.052–4.622), and an American Society of Anesthesiologists (ASA) score ≥II (OR 2.195; 95% CI 1.052–4.746). Independent risk factors for hospital stay ≥15 days (P < 0.001) were age ≥70 years (OR 2.438; 95% CI 1.122–5.299) and an ASA score ≥II (OR 2.348; 95% CI 1.109–4.968). The PA score included age, ASA score, and pre‐albumin level. The complication rate for each PA score was as follows: score “0”, 12.1%; score “1”, 18.2%; score “2”, 26.9%; score “3”, 30.8%; and score “≥4”, 47.2%. Conclusions Advanced age, poor nutrition, and serious illnesses can cause ERAS protocol failure. The PA score is effective for predicting postoperative progress. Highlight Enhanced recovery after surgery (ERAS) protocols for pancreatoduodenectomy have shortened the length of hospital stay and reduced complications, but they are not effective for all patients. Kobayashi and colleagues devised a scoring system to predict ERAS protocol failure, and identified advanced age, poor nutrition, and serious comorbidities as risk factors.