Intensive Care Unit Enhanced Recovery Pathway for Patients Undergoing Orthotopic Liver Transplants Recipients: A...

Area of Science:

• Transplantation Medicine
• Surgical Critical Care
• Enhanced Recovery Pathways

Background:

• Liver transplant recipients exhibit high perioperative resource utilization and prolonged hospital stays.
• Enhanced recovery pathways (ERPs) have demonstrated success in reducing resource utilization in other surgical fields.

Purpose of the Study:

• To evaluate the impact of an enhanced recovery pathway on postoperative care and outcomes in liver transplant recipients.
• To compare outcomes of liver transplant patients managed with an ERP versus traditional care.

Main Methods:

• A prospective, observational study compared outcomes of 141 liver transplant patients managed with an ERP to 106 control patients from the prior year.
• Multivariable regression analysis assessed the association between the ERP and clinical outcomes.
• Key metrics included intensive care unit (ICU) length of stay, discharge timing, transfusion rates, mortality, readmissions, and infections.

Main Results:

• The ERP group experienced a significant reduction in median ICU length of stay (4.4 to 2.6 days).
• Patients on the ERP had a higher likelihood of earlier discharge (HR, 2.01) and significantly lower odds of receiving plasma (69% reduction) or packed red blood cell (65% reduction) transfusions.
• No significant differences were observed in hospital mortality, ICU readmission rates, or postoperative infections.

Conclusions:

• An enhanced recovery pathway, focusing on milestone-based ICU management and specific triggers, effectively reduced ICU length of stay in liver transplant recipients.
• The pathway achieved these reductions without increasing perioperative complications, highlighting its safety and efficacy.