Fast-track protocols in laparoscopic liver surgery: Applicability and correlation with difficulty scoring systems

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Protocols

Background:

• Limited data exists on the effectiveness of fast-track protocols (FTP) in minimally invasive liver surgery.
• Evaluating FTP applicability is crucial for optimizing patient recovery and hospital resource utilization.

Purpose of the Study:

• To assess the feasibility and applicability of FTP in minimally invasive liver surgery.
• To correlate FTP adherence with established surgical difficulty scores (Iwate, Southampton, Gayet).

Main Methods:

• Analysis of patients undergoing minimally invasive liver surgery since 2014.
• Comparison of Iwate, Southampton, and Gayet scores as predictors of FTP adherence.
• Multivariate analysis to identify factors influencing discharge time (<24h, <72h), complications, and readmissions.

Main Results:

• 71.5% of eligible patients achieved FTP discharge within 72 hours.
• The Iwate score demonstrated the highest accuracy (AUC 0.780) in predicting discharge within 24 hours.
• Body mass index was identified as an independent risk factor for prolonged stay (>72h) and complications, irrespective of difficulty scores.

Conclusions:

• Aggressive FTP implementation is achievable in minimally invasive liver surgery, facilitating early discharge even for complex cases.
• Surgical difficulty scores, incorporating body mass index, can aid in predicting patient suitability for FTP.
• FTP optimization holds potential for improved patient outcomes and efficient surgical practice.