Decreased Length of Stay and Opioid Usage After Liver Cancer Surgery With Enhanced Recovery Pathway Implementation

Area of Science:

• Oncology
• Surgery
• Anesthesiology

Background:

• Enhanced recovery after surgery (ERAS) pathways are established for improving postoperative recovery.
• Evidence for ERAS in liver cancer surgery, particularly within the US veteran population, is limited.
• This study addresses the impact of ERAS on liver cancer surgery outcomes in US veterans.

Purpose of the Study:

• To evaluate the effectiveness of an ERAS pathway for liver cancer surgery in US veterans.
• To assess the impact of ERAS on length of stay and perioperative opioid consumption.
• To determine the feasibility of implementing ERAS in this specific patient cohort.

Main Methods:

• A retrospective quality improvement study comparing patients before and after ERAS implementation.
• Inclusion of elective open hepatectomy or microwave ablation for liver tumors.
• Integration of preoperative, intraoperative, and postoperative interventions, including erector spinae plane block for analgesia.

Main Results:

• A significant decrease in the length of hospital stay was observed in the ERAS group (4.1 days) compared to traditional care (8.6 days).
• Perioperative opioid consumption was substantially reduced, including intraoperative (49.8 mg vs 98 mg) and postoperative (65.3 mg vs 175.7 mg) use.
• Patient-controlled analgesia use dropped to 0% in the ERAS group from 50% in the pre-ERAS group.

Conclusions:

• Implementation of ERAS pathways for liver cancer surgery in US veterans leads to reduced length of stay and perioperative opioid consumption.
• Despite limitations of a single-institution quality improvement project with a small sample size, results are clinically and statistically significant.
• Further investigation is warranted to confirm ERAS efficacy for the growing surgical needs of the US veteran population.