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Applicability of enhanced recovery program for advanced liver surgery
Takeshi Takamoto1, Takuya Hashimoto, Kazuto Inoue
1Division of Hepato-Biliary-Pancreatic Surgery and Transplantation Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan, takamoto@nifty.com.
World Journal of Surgery
|May 20, 2014
Summary
Enhanced recovery programs (ERPs) can be safely applied to major liver surgery patients, with over 80% achieving successful recovery. Key factors for delayed recovery include advanced age and blood transfusions, necessitating individualized fluid management.
Area of Science:
- Hepatobiliary Surgery
- Surgical Outcomes
- Patient Recovery Protocols
Background:
- Enhanced recovery programs (ERPs) optimize surgical recovery across disciplines.
- The application of ERPs in complex liver surgery, particularly with liver failure risks, requires investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of an enhanced recovery program (ERP) in patients undergoing major hepatectomy.
- To identify factors influencing successful ERP completion in liver surgery patients.
Main Methods:
- An ERP incorporating enhanced perioperative education, individualized fluid therapy, and early mobilization was implemented for major hepatectomy patients (2008-2013).
- ERP success was defined by independence from continuous medical intervention by postoperative day 6.
- Risk factors for delayed ERP accomplishment were analyzed.
Main Results:
- 165 out of 200 patients (82.5%) successfully completed the ERP.
- Independent risk factors for delayed accomplishment included age (≥65 years) and red blood cell transfusion.
- Early oral intake (POD 1) was achieved in 89.5%, and IV fluid cessation by POD 5 in 72.5%.
Conclusions:
- An ERP is feasible and achievable in over 80% of major hepatectomy patients.
- Earlier bowel movement remains a challenge.
- Individualized fluid management is crucial, especially for elderly patients or those receiving transfusions.
