Fast-Track Programs for Liver Surgery: A Meta-Analysis

Abstract

Fast-track surgery programs are feasible and effective for liver surgery. Future studies should optimize fast-track surgery programs catering to liver surgery.

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

“…Our findings suggested that LOS was significantly reduced by 2.22 days in the ERAS group, which is similar to previous findings of others. [8][9][10][12][13][14] However, there was a significant heterogeneity in the analysis, which could not be eliminated even after conducting a sensitivity analysis. Moreover, the significant heterogeneity did not disappear even after two studies from Liang and associates which included patients less than 18 years old were removed from the analysis, neither did removing studies that reported median and range or applying a fixed model to the analysis eliminated the significant heterogeneity.…”

“…7 Moreover, several reviews concluded that the implementation of ERAS protocols is associated with a significant reduction in length of hospital stay and postoperative complications without increasing mortality and readmission rates. [7][8][9][10][11][12][13][14] However, evidence on cost-effectiveness and compliance to ERAS protocols in liver surgery is limited. Two previous meta-analyses have demonstrated a significant reduction in hospital expenditure following implementation of ERAS protocols in liver surgery.…”

“…Two previous meta-analyses have demonstrated a significant reduction in hospital expenditure following implementation of ERAS protocols in liver surgery. 9,10 The conclusion reached by these reviews was either based on low-quality RCTs and cohort studies without conducting a separate meta-analysis of RCTs and cohort studies. Furthermore, to date, no review has investigated overall protocol compliance which is a key factor to delivering a successful implementation of ERAS protocols.…”

Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary?

“…Enhanced recovery after surgery (ERAS) programs are one of the most promising approaches to optimize postoperative outcomes after abdominal surgery, whether it is elective or emergency surgery [9]. The feasibility and safety of fast-track (FT) programs have been validated in colorectal [10], hepatic [11], and pancreatic surgery [12,13]. Fast-track perioperative care employs a number of elements aimed at enhancing recovery and reducing the profound stress response after surgery.…”

“…The rate of DGE (grade B-C according to ISGPS classification) was significantly higher in the NGT+ group compared to the NGT− group (45.5% vs. 7.5%, P<0.001). Consequently, the length of postoperative hospital stay was significantly shorter in the NGT− group[10 (8-14.2) vs. 14(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) days, P = 0.005].…”