Enhanced Recovery after Surgery Programs for Liver Resection: a Meta-analysis

Wang, Cheng; Zheng, Guoqun; Zhang, Wenlong; Zhang, Fabiao; Lv, Shangdong; Wang, Aidong; Fang, Zheping

doi:10.1007/s11605-017-3360-y

Cited by 53 publications

(54 citation statements)

References 46 publications

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“…The ERAS guidelines have proposed that malnourished patients, such as patients with a lower albumin level, should receive oral nutritional supplements preoperatively to improve nutritional status. Furthermore, recent meta-analyses have demonstrated the significant effect of ERAS programs on the postoperative outcomes of patients undergoing hepatectomy [21][22][23]. In the present study, we did not use a single additional perioperative nutrition program to malnourished patients.…”

Section: Discussionmentioning

confidence: 88%

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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Background: Preoperative nutritional status is reportedly associated with postoperative outcomes in patients with hepatocellular carcinoma. This study aimed to investigate the significance of the controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) as predictors of postoperative outcomes. Methods: We retrospectively reviewed data from 331 patients who underwent hepatectomy for hepatocellular carcinoma between January 2007 and December 2015. Patients were divided into 2 groups based on their CONUT score and the PNI. We evaluated the effect of the CONUT score and PNI on perioperative outcomes. Multivariate analysis was performed to identify independent predictors of in-hospital mortality after hepatectomy. Results: The high CONUT group had a significantly higher incidence of 30-day mortality (p < 0.001), in-hospital mortality (p = 0.002), ascites (p = 0.006), liver failure (p = 0.02), sepsis (p = 0.01), and enteritis (p < 0.001). The low PNI group was also significantly associated with 30-day mortality (p < 0.001), in-hospital mortality (p = 0.003), liver failure (p < 0.001), sepsis (p = 0.02), enteritis (p = 0.02), and hospital stay (p = 0.01). In multivariate analyses, a high CONUT score was an independent predictor of in-hospital mortality after hepatectomy (hazard ratio [HR] 9.41, p = 0.038), but the PNI was not (HR 5.86, p = 0.08). Conclusions: Preoperative assessment of the CONUT score is helpful for evaluating patients’ nutritional status and mortality risk after liver surgery.

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Section: Discussionmentioning

confidence: 88%

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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“…Postoperative morbidity after hepatic surgery was reduced in ERAS (28%) versus conventional care (38%). Readmission and mortality rates after hepatic surgery were not significantly different between ERAS and conventional care …”

Section: Eras Outcomes In Hpbmentioning

confidence: 83%

“…The postoperative complication rates however remain high for even the most experienced centers . A recent meta‐analysis showed a reduction in length of stay of 2 days for ERAS in a pooled data group of 2504 patients . Postoperative morbidity after hepatic surgery was reduced in ERAS (28%) versus conventional care (38%).…”

Section: Eras Outcomes In Hpbmentioning

confidence: 99%

ERAS: Improving outcome in the cachectic HPB patient

Dijk

Woerden

Cakir

et al. 2017

Journal of Surgical Oncology

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The enhanced recovery after surgery (ERAS) program has reduced postoperative morbidity and duration of hospital stay but not mortality in patients undergoing hepatopancreatobiliary (HPB) surgery. Many HPB patients suffer from cancer cachexia, a syndrome of severe weight and muscle loss. This may affect outcomes of HPB surgery even within an ERAS program. A tailored ERAS approach may be essential in further improving outcome in this vulnerable patient category.

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“…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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Enhanced Recovery after Surgery Programs for Liver Resection: a Meta-analysis

Abstract: Enhanced recovery after surgery programs for hepatectomy are feasible and efficient. Further studies should optimize perioperative outcomes for liver surgery.

Cited by 53 publications

References 46 publications

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

ERAS: Improving outcome in the cachectic HPB patient

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

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