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Enhanced recovery protocol after liver resection.

J Savikko1, M Ilmakunnas2, H Mäkisalo1

  • 1Departments of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland.

The British Journal of Surgery
|September 3, 2015
PubMed
Summary

Enhanced recovery protocols (ERPs) safely and effectively improve liver surgery outcomes. Patients experienced shorter hospital stays and good satisfaction with no increase in adverse events.

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Outcomes
  • Perioperative Care

Background:

  • Enhanced recovery protocols (ERPs) optimize perioperative care to accelerate patient recovery and reduce hospital stays.
  • Limited experience exists with ERPs specifically in liver surgery.

Purpose of the Study:

  • To evaluate the implementation and effectiveness of a multimodal enhanced recovery protocol in patients undergoing open and laparoscopic liver surgery.

Main Methods:

  • A multimodal ERP was implemented, focusing on opioid-sparing pain management, early mobilization, oral feeding, and restricted use of drains and catheters.
  • Outcomes assessed included date to discharge, postoperative complications, and patient satisfaction.
  • A historical cohort of liver resection patients served as a control group.

Main Results:

  • 134 liver resections (126 open, 8 laparoscopic) were performed, primarily for malignant liver tumors.
  • Median postoperative hospital stay was 4 days in the ERP group, significantly shorter than the 6 days in the control group (P < 0.001).
  • 79.1% of patients were discharged by postoperative day 5, with zero 30-day mortality and only four readmissions.

Conclusions:

  • An enhanced recovery protocol can be safely and effectively introduced for perioperative care following liver surgery.
  • Achieving discharge within 4 days is feasible without increasing adverse events, alongside good patient satisfaction.