Patient outcomes and provider perceptions following implementation of a standardized perioperative care pathway for open liver resection

Abstract

The introduction of a multimodal ERAS programme following open liver surgery was associated with a reduction in opioid use, shorter hospital stay and decreased hospital costs. ERAS was endorsed by an overwhelming majority of providers.

Patterns of hepatic resections in North America: use of concurrent partial resections and ablations

“…[1][2][3][4][5] Although careful patient selection, improved operative technique, and more developed perioperative care pathways have resulted in decreased perioperative morbidity and mortality following liver resection, a significant proportion of patients presenting with hepatocellular carcinoma (HCC), colorectal liver metastasis (CRLM) or biliary malignancies are not candidates for curative resection due to inadequate functional hepatic reserve, multifocal disease or a combination of both. 3,[6][7][8][9] For patients who are not candidates for surgical resection due to multifocal disease, adjunct locoregional therapies including the concurrent use of thermal or alcohol ablation has been proposed. [10][11][12] Combining hepatectomy with ablation permits the removal of the largest tumors while simultaneously ablating any smaller residual tumors.…”

Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy

“…Standardized care maps for a specific procedure might be a way to facilitate perioperative management by standardising and ease pre-, intra- and postoperative care [4]. This standardization aims to simplify work for caregivers and might be especially useful in frequently performed surgical procedures like laparoscopic cholecystectomy.…”

“…The beneficial effect of standardization has been repeatedly shown within Enhanced Revovery After Surgery (ERAS) pathways [16], coming along with decreased nursing workload [17] and increased patient and provider satisfaction [4]. Further, besides clinical benefits, economically relevant benefits for the utilization of standardised clinical pathways with reduction in use of resources have been described [18].…”

Parenchymal-sparing Hepatectomy as the New Doctrine in the Treatment of Liver-metastatic Colorectal Disease: Beyond Oncological Outcomes

“…For example, the per-patient cost of a hepatic resection at low-volume centers was recently reported to be 21.9% higher than at high-volume centers (35). Even at high-volume centers, ERAS strategies can drive down costs even further among patients undergoing hepatic resection (36). Future payment models are likely increasingly to be adopted that will bundle or cap reimbursement, limiting hospital payment, especially in the setting of a complicated postoperative course (37).…”