Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection

Dam, Ronald M. van; Hendry, P. O.; Coolsen, M. M. E.; Bemelmans, M. H. A.; Lassen, Kristoffer; Revhaug, Arthur; Fearon, Kenneth C. H.; Garden, O. J.; Dejong, Cornelis H. C.

doi:10.1002/bjs.6227

Cited by 207 publications

(235 citation statements)

References 29 publications

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“…Although several studies supported the positive impact of enhanced recovery pathway on recovery, they did not thoroughly analyse functional recovery following liver surgery 8,9,24 . In this regard, the present results showed an improvement of pain control, duration of intravenous fluid and full mobilization, after liver ERAS implementation.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a Positive Impact on Non‐ERAS Liver Surgery Patients

et al. 2015

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Section: Discussionmentioning

confidence: 99%

“…As a result, ERAS protocols were subsequently extended to other types of surgery, including gastric 6 , pancreatic 7 and liver 8 surgery. The use of ERAS protocols in liver surgery appeared to be safe and feasible [9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a Positive Impact on Non‐ERAS Liver Surgery Patients

et al. 2015

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“…Although compliance data with enhanced recovery after surgery (ERAS) protocols were not available, most core items are considered to be well implemented in Norway, reflecting communications at national symposia, involvement in the ERAS ® Society guidelines and consensus papers16, 17, 18, 19, 20.…”

Section: Discussionmentioning

confidence: 99%

Benchmarking of aggregated length of stay after open and laparoscopic surgery for cancers of the digestive system

et al. 2018

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BackgroundLength of hospital stay (LOS) may serve as a surrogate measure of healthcare quality and resource use, particularly when transfers of care and readmissions are accounted for. This study aimed to benchmark true hospital stay by measuring index, transfer and readmission stays across the range of digestive cancer surgery.MethodsA cohort study of all patients undergoing resection for cancer of the oesophagus, stomach, liver, pancreas, colon or rectum in 2012–2016 was undertaken. Index LOS, transfer and readmission stays were merged into an ‘aggregated’ length of stay (a‐LOS), and compared between organ sites and between open and minimal‐access approaches.ResultsIn total, 24 354 resections were reported (mean age of patients 68·3 years; 51·3 per cent were men). Resections were reported as laparoscopic for 9151 procedures (37·6 per cent), with a further 283 (3·0 per cent) described as converted to open surgery. Use of a‐LOS compared with standard LOS added a median of 5 days for pancreatoduodenectomy, 4 days for major liver resections, 3 days for oesophageal and gastric resections, and 2 days for minor liver, distal pancreatic and rectal resections.ConclusionOverall hospital stay across organ sites and procedures is better described by a‐LOS. The study benchmarks the use of total hospital days during the first 30 days in a universal healthcare system.

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“…Many units are now incorporating HRS patients into enhanced recovery programs with early targets for introduction of enteral diet, mobilization, prompt removal of invasive monitoring devices, reduction in the use of opiate analgesia, and judicious use of intravenous fluids [41][42][43] . These measures mean that most patients will expect to stay less than a week following their surgery.…”

Section: Managementmentioning

confidence: 99%

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Farid

Prasad²,

Morris‐Stiff³

2013

WJGS

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Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients. Core tip: Applied anatomy as used in hepatic surgery is different to the traditional morphological teaching. Applied hepatic anatomy is complex but trainees require an understanding of the basic principles to allow an appreciation of the operations performed. Complications require a low threshold of suspicion as they often have important consequences in relation to patient outcome. Recognition of such with rapid alerting of senior staff can facilitate timely and effective management. To date, no universal protocol exists for management of the post-operative period and varies from centre to centre. We provide a practical overview of the terminology, post-operative management, and complications associated with hepatic surgery.

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Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection

Abstract: The ERAS fast-track protocol is safe and effective for patients undergoing liver resection. It allows early oral intake, promotes faster postoperative recovery and reduces hospital stay.

Cited by 207 publications

References 29 publications

Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a Positive Impact on Non‐ERAS Liver Surgery Patients

Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a Positive Impact on Non‐ERAS Liver Surgery Patients

Benchmarking of aggregated length of stay after open and laparoscopic surgery for cancers of the digestive system

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

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