Effects of implementing an “enhanced recovery after surgery” program on patients undergoing resection of hepatocellular carcinoma

Kaibori, Masaki; Matsui, Kosuke; Ishizaki, Morihiko; Iida, Hiroya; Yoshii, Kengo; Asano, Hiroaki; Kon, Masanori

doi:10.1007/s00595-016-1344-2

Cited by 34 publications

(21 citation statements)

References 39 publications

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“…Six studies were RCTs, 22,25,28,29,32,35 16 were case-control studies 2, 18, 21, 23, 24, 27, 31, 33, 36-42 and five prospective studies. 19,20,26,30,34 Eleven studies included both open and laparoscopic surgery in the study, 19-21, 23, 24, 27, 33, 35, 37, 39, 40 ten studies included only open liver surgery patients, 2, 18, 25, 26, 30-32, 34, 41, 42 five studies included only laparoscopic surgery patients, 22,28,29,36,38 whilst one study performed a separate analysis for laparoscopic surgery and open surgery. 21 A detailed characteristic of included studies is shown in Table 1.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Noba

Rodgers

Chandler

et al. 2020

Journal of Gastrointestinal Surgery

154

101

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Background Enhanced recovery after surgery (ERAS) protocols are evidence-based, multimodal and patient-centred approach to optimize patient care and experience during their perioperative pathway. It has been shown to be effective in reducing length of hospital stay and improving clinical outcomes. However, evidence on its effective in liver surgery remains weak. The aim of this review is to investigate clinical benefits, cost-effectiveness and compliance to ERAS protocols in liver surgery. Methods A systematic literature search was conducted using CINAHL Plus, EMBASE, MEDLINE, PubMed and Cochrane for randomized control trials (RCTs) and cohort studies published between 2008 and 2019, comparing effect of ERAS protocols and standard care on hospital cost, LOS, complications, readmission, mortality and compliance. Results The search resulted in 6 RCTs and 21 cohort studies of 3739 patients (1777 in ERAS and 1962 in standard care group). LOS was reduced by 2.22 days in ERAS group (MD = −2.22; CI, −2.77 to −1.68; p < 0.00001) compared to the standard care group. Fewer patients in ERAS group experienced complications (RR, 0.71; 95% CI, 0.65-0.77; p = < 0.00001). Hospital cost was significantly lower in the ERAS group (SMD = −0.98; CI, −1.37 to-0.58; p < 0.0001). Conclusion Our review concluded that the introduction of ERAS protocols is safe and feasible in hepatectomies, without increasing mortality and readmission rates, whilst reducing LOS and risk of complications, and with a significant hospital cost savings. Laparoscopic approach may be necessary to reduce complication rates in liver surgery. However, further studies are needed to investigate overall compliance to ERAS protocols and its impact on clinical outcomes.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Noba

Rodgers

Chandler

et al. 2020

Journal of Gastrointestinal Surgery

154

101

View full text Add to dashboard Cite

show abstract

“…In addition, it is possible that hospitals with a shorter LOS, particularly within the more recent time period, have a higher proportion of patients undergoing laparoscopic liver resection and/or that those hospitals have adopted an enhanced recovery pathway for liver resection patients. Both laparoscopy and enhanced recovery have been associated with reduced complications and shorter LOS . It is unclear if these specific hospital traits are related to volume alone, other factors or a combination thereof.…”

Section: Discussionmentioning

confidence: 99%

“…Both laparoscopy and enhanced recovery have been associated with reduced complications and shorter LOS. [31][32][33][34] It is unclear if these specific hospital traits are related to volume alone, other factors or a combination thereof.…”

mentioning

confidence: 99%

Surrogate indicators of quality are associated with survival following surgical treatment for hepatocellular carcinoma

Roife

Santamaria-Barria

Kao

et al. 2018

Journal of Surgical Oncology

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“…These findings show the importance of improving perioperative care to reduce morbidity rates among patients undergoing hepatectomy. ERAS protocols have been reported to be effective for patients undergoing hepatectomy since they lead to shorter hospitalization duration and reduced morbidity [6][7][8][9][10], although the quality and level of evidence for their efficacy are still lower than those for ERAS protocols for patients undergoing colorectal surgery. Therefore, we performed a randomized controlled trial (RCT) to determine whether an ERAS protocol is more effective compared to conventional postoperative management in patients undergoing open hepatectomy in our department.…”

Section: Introductionmentioning

confidence: 99%

Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial

et al. 2020

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Purpose: Enhanced recovery after surgery (ERAS) is beneficial to patients undergoing digestive surgery. However, its efficacy in patients undergoing open hepatectomy remains unclear. Methods: Consecutive patients scheduled for open hepatectomy were randomly assigned to undergo either ERAS or conventional postoperative management. The primary endpoint was the amount of time that elapsed before patients were considered medically fit for discharge (MFD) and length of hospital stay (LOHS). Secondary endpoints included morbidity, mortality, the time to first flatus, defecation, first walk, and freedom from infusion. Perioperative serum nutritional markers, insulin resistance, respiratory quotient (RQ), and resting energy expenditure (REE) were also assessed. Results: Between August 2014 and March 2017, 57 patients were randomized into 2 groups; ERAS group (n = 29) and conventional management (n = 28). The median MFD was not significantly different between the ERAS and conventional management groups (6.5 vs. 7 days; P = 0.381). Recovery from gastrointestinal paresis was significantly quicker in the ERAS group (1.8 vs. 2.4 days; P = 0.004). There were no significant differences in serum markers, insulin resistance, RQ, and REE. Conclusion: This trial did not demonstrate greater efficacy of the ERAS protocol following open hepatectomy in terms of the MFD and LOHS. However, the ERAS protocol was associated with better recovery from postoperative gastrointestinal paresis, suggesting that it is useful for patients undergoing open hepatectomy.

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Effects of implementing an “enhanced recovery after surgery” program on patients undergoing resection of hepatocellular carcinoma

Abstract: The ERAS program was feasible and effective for patients with chronic liver disease undergoing extended liver resection for HCC, because it allowed earlier oral dietary intake and promoted faster postoperative recovery.

Cited by 34 publications

References 39 publications

Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Surrogate indicators of quality are associated with survival following surgical treatment for hepatocellular carcinoma

Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial

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