Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial

Liang, Xiao; Ying, Hanning; Wang, Hongwei; Xu, Hongxia; Liu, Minjun; Zhou, Haiyan; Ge, Huiqing; Jiang, Wenbin; Lin, Feng; Liu, Hui; Zhang, Yingchun; Mao, Zhiying; Li, Jianhua; Shen, Bo; Liang, Yuelong; Cai, Xiujun

doi:10.1007/s00464-017-5973-3

Cited by 47 publications

(54 citation statements)

References 51 publications

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“…One way of measuring and monitoring compliance within ERAS programme is through systematic audit. 5 However, only 18.5% (5/27) of the included studies reported performing a systematic audit 20,24,27,28,40 to monitor of ERAS elements within the ERAS programme.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Five of the studies reported hospital cost in US dollar, 21,22,29,35,41 three in Chinese yuan 28,30,42 and two in euros. 24,33 One study reported 30% reduction in hospital cost in ERAS group without providing further data, 36 and one did not provide data on overall hospital cost.…”

Section: Hospital Costmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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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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“…Laparoscopic liver surgery (LLS) has evolved over the past two decades and is today a widely accepted standard of practice [1,2]. Recently it has been shown in randomized controlled trials that LLS is associated with significantly less postoperative complications and pain than open surgery [3,4]. In addition, LLS also showed superior cost-effectivity [3].…”

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confidence: 99%

Enhanced recovery protocol in laparoscopic liver surgery

et al. 2020

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Introduction Enhanced recovery protocols (ERP) accelerate recovery and shorten postoperative hospital stay. This increased knowledge of ERPs has also gradually implemented into liver surgery. However, in laparoscopic liver surgery (LLS), the experience of optimized perioperative care protocols is still limited. Methods We prospectively studied the implementation of multimodal ERP principles to LLS in the first 100 consecutive patients. Opioid-sparing multimodal pain management was applied together with early mobilization already in the postoperative care unit (PACU). Drains and catheters were avoided and per oral intake was initiated promptly. Primary pain control was achieved with iv NSAIDS, low-dose opioid and corticosteroids. Combination of per oral ibuprofen and long-acting tramadol was routinely administered shortly after operation. The multiprofessional adherence to the protocol was also evaluated. Results Investigated LLS was performed during Aug 2016-Apr 2019. Operations were done due to malignancy in 83 (83%) of cases, mostly for colorectal liver metastases (n = 52, 52%). Forty-eight (48%) of the operated patients were female. Median age was 65 years (range 17-91). The American Society of Anaesthesiologists Physical Status (ASA) classification median was three. Median postoperative hospital stay was 2 days (range 1-8 days). More than seventy percent of patients were discharged by the second postoperative day and nearly ninety percent by the third postoperative day. Complications after surgery were few. The new ERP elements were adopted in most of the cases. Conclusions ERP was introduced safely and effectively after LLS. The adherence to the ERP was good. Routine discharge 1-2 days after LLS is realistic and achievable.

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“…Enhanced recovery after surgery (ERAS) programs have been applied for patients receiving smallscale and large-scale liver resection [13,14]. A number of studies have shown that ERAS programs are safe, feasible and effective in reducing the median LOS in both open and laparoscopic resection [15,16]. In some retrospective trials comparing earlier recovery or a reduction in LOS, perioperative evaluation or management was not uniform [12,17].…”

Section: Introductionmentioning

confidence: 99%

Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: study protocol for a randomized controlled trial

pan¹,

Wu²,

Zhou³

et al. 2020

Preprint

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Background : The advantages of laparoscopic left-sided hepatectomy (LLH) for treating hepatolithiasis in terms of the time to functional recovery , postoperative length of hospital stay (LOS), morbidity, long-term abdominal wall hernias, hospital costs, residual stone rate and recurrence of calculus have not been confirmed by a randomized controlled trial. The aim of this trial is to compare the safety and effectiveness of LLH to those of open left-sided hepatectomy (OLH) for the treatment of hepatolithiasis. Methods: Patients with hepatolithiasis eligible for left-sided hepatectomy will be recruited. The experimental design will produce two randomized arms (laparoscopic and open hepatectomy) at a 1:1 ratio and a prospective registry. All patients will undergo surgery in the setting of an enhanced recovery after surgery (ERAS) program. The prospective registry will be based on patients who cannot be randomized because of the explicit treatment preference of the patient or surgeon or because of ineligibility (not meeting the inclusion and exclusion criteria) for randomization in this trial. The primary outcome is the time to functional recovery. The secondary outcomes are LOS, percentage readmission, morbidity, mortality, hospital costs, long-term incidence of incisional hernias, residual stone rate and recurrence of calculus. It will be assumed that, in patients undergoing LLH, the length of hospital stay will be reduced by 1.3 days. A sample size of 44 patients in each randomization arm has been calculated as sufficient to detect a 1.3-day reduction in LOS (90% power and α = 0.05 (two-tailed)). The trial is a randomized controlled trial that will provide evidence for the merits of laparoscopic surgery in patients undergoing liver resection within an ERAS program. Discussion: Although the outcomes of LLH have been proven to be comparable to those of OLH in retrospective studies, the use of LLH remains restricted, partly due to the lack of short-and long-term informative RCTs pertaining to patients with hepatolithiasis in ERAS programs. To evaluate the surgical and long-term outcomes of LLH, we will perform a prospective RCT to compare LLH with OLH for hepatolithiasis within an ERAS program. Trial registration: ClinicalTrials.gov NCT03958825 . Keywords: Laparoscopic, open liver resection, ERAS, Hepatectomy

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Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial

Abstract: ERAS protocol is feasible and safe for laparoscopic liver resection. Patients in ERAS group have less pain and complications.

Cited by 47 publications

References 51 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

Enhanced recovery protocol in laparoscopic liver surgery

Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: study protocol for a randomized controlled trial

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