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Enhanced recovery after liver surgery.

R Brustia1, K Slim2, O Scatton3

  • 1Service de chirurgie digestive, hépatobiliopancreatique et transplantation hépatique, hôpital Pitié Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Universités, 21, rue de l'École-de-Médecine, 75006 Paris, France; Unité de Recherche BQR SSPC « Simplification des Soins des Patients Complexes » Université de Picardie Jules Verne, 80080 Amiens, France.

Journal of Visceral Surgery
|November 19, 2018
PubMed
Summary

Enhanced recovery after surgery programs (ERP) significantly reduce complications by 30-60% in liver surgery, shortening hospital stays. While not impacting readmission or mortality, ERP improves patient outcomes and functional recovery.

Keywords:
Enhanced recovery after surgeryHepatectomyLiver surgerySystematic review

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Outcomes Research
  • Multidisciplinary Care Models

Background:

  • Enhanced Recovery After Surgery (ERP) programs are proven to reduce complications and hospital stays in digestive surgery.
  • Liver surgery has high morbidity and mortality rates, making ERP implementation highly relevant.
  • ERP involves preoperative, perioperative, and postoperative measures managed by a multidisciplinary team.

Purpose of the Study:

  • To systematically review the efficacy of Enhanced Recovery After Surgery (ERP) programs in liver surgery.
  • To evaluate the impact of ERP on complication rates, hospital stay, and functional recovery in liver surgery patients.

Main Methods:

  • A systematic narrative review of existing literature.
  • Inclusion of studies on ERP in liver surgery performed via laparotomy or laparoscopy.
  • Analysis of 30 studies, including randomized trials, cohort studies, and meta-analyses.

Main Results:

  • ERP is associated with a 30-60% decrease in overall complications for liver surgery.
  • Average length of stay (ALOS) reduced by 2.3 days; functional recovery improved by 2.5 days.
  • Laparoscopic surgery independently improves outcomes and should be integrated into ERP.

Conclusions:

  • Enhanced Recovery After Surgery (ERP) is a valuable care improvement process for organizing liver surgery.
  • Large-scale application of ERP in liver surgery is recommended to enhance patient outcomes.
  • Addressing implementation barriers through team leadership and training is crucial for successful ERP adoption.