Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study

Dasari, B.; Rahman, Rasha Wessam Abdel; Khan, Shakeeb; Bennett, Davinia; Hodson, James; Isaac, John; Marudanayagam, R.; Mirza, Darius F.; Muiesan, Paolo; Roberts, Keith; Sutcliffe, Robert P.

doi:10.1111/hpb.12447

Cited by 31 publications

(43 citation statements)

References 39 publications

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“…Despite Dunne (14) reporting similar length of stay, that study was indeed a comparison of early versus late cohort of patients treated with the same protocol and there was reduction in number of patients staying more than 10 days. Dasari et al (15) reported similar findings, however pre-ERAS and post-ERAS cohorts are difficult to compare since author unit already practiced some fast-track elements in their perioperative care before introduction of standardized protocol. Overall morbidity seems not to be affected by ERAS management, with some studies demonstrating decrease in medical and low-grade Clavien grade I-II complications.…”

Section: Discussionmentioning

confidence: 85%

“…Overall morbidity seems not to be affected by ERAS management, with some studies demonstrating decrease in medical and low-grade Clavien grade I-II complications. The only study reporting decrease in major complications (grade III-V) is by Dasari et al (15), which appears to be mostly secondary to higher rate of intra-abdominal collections. There are no details given on a nature of intra-abdominal collections but in reviewing both pre-ERAS and ERAS cohorts, there is increased number of extended resections, open hepatectomy, hepatocellular (10) reported increase in readmission rates with parallel decrease of length of stay under ERAS protocol below 4 days while overall complication rate was unaffected.…”

Section: Discussionmentioning

confidence: 95%

“…Fifteen studies were identified (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). All studies excluded patients with complex biliary or vascular reconstructions.…”

Section: Resultsmentioning

confidence: 99%

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Impact of enhanced recovery after surgery protocols on postoperative morbidity and mortality in patients undergoing routine hepatectomy: review of the current evidence

Damania

Cocieru

2017

Ann. Transl. Med.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 95%

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Impact of enhanced recovery after surgery protocols on postoperative morbidity and mortality in patients undergoing routine hepatectomy: review of the current evidence

Damania

Cocieru

2017

Ann. Transl. Med.

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“…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%

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

152

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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“…Intermittent inflow vascular control was obtained based on the extent of resection and surgeon preference. Abdominal drains were used after most resections, but were removed according to an enhanced recovery protocol (in use in the department since 2014). Anatomical remnant liver volumes were measured selectively in patients requiring extended hepatectomy.…”

Section: Methodsmentioning

confidence: 83%

Propensity-matched analysis of the influence of perioperative statin therapy on outcomes after liver resection

et al. 2019

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Background Perioperative use of statins is reported to improve postoperative outcomes after cardiac and non‐cardiovascular surgery. The aim of this study was to investigate the influence of statins on postoperative outcomes including complications of grade IIIa and above, posthepatectomy liver failure (PHLF), and 90‐day mortality rates after liver resection. Methods Patients who underwent hepatectomy between 2013 and 2017 were reviewed to identify statin users and non‐users (controls). Propensity matching was conducted for age, BMI, type of surgery and preoperative co‐morbidities to compare subgroups. Univariable and multivariable analyses were performed for the following outcomes: 90‐day mortality, significant postoperative complications and PHLF. Results Of 890 patients who had liver resection during the study period, 162 (18·2 per cent) were taking perioperative statins. Propensity analysis selected two matched groups, each comprising 154 patients. Overall, 81 patients (9·1 per cent) developed complications of grade IIIa or above, and the 90‐day mortality rate was 3·4 per cent (30 patients), with no statistically significant difference when the groups were compared before and after matching. The rate of PHLF was significantly lower in patients on perioperative statins than in those not taking statins (10·5 versus 17·3 per cent respectively; P = 0·033); similar results were found after propensity matching (10·4 versus 20·8 per cent respectively; P = 0·026). Conclusion The rate of PHLF was significantly lower in patients taking perioperative statins, but there was no statistically significant difference in severe complications and mortality rates.

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Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study

Abstract: Enhanced recovery after a liver resection appears to be safe, feasible and may reduce severe complications. However, the LOS was significantly influenced by patient age, open surgery and post-operative complications, but not by an ERP.

Cited by 31 publications

References 39 publications

Impact of enhanced recovery after surgery protocols on postoperative morbidity and mortality in patients undergoing routine hepatectomy: review of the current evidence

Impact of enhanced recovery after surgery protocols on postoperative morbidity and mortality in patients undergoing routine hepatectomy: review of the current evidence

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

Propensity-matched analysis of the influence of perioperative statin therapy on outcomes after liver resection

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