Enhanced recovery after surgery society's recommendations for liver surgery reduces non surgical complications

Enhanced Recovery after Surgery (ERAS) is a multimodal approach to improve surgical outcome and has been implemented in many fields of surgery in an international scale. The aim of this study was to evaluate the effect of the Enhanced Recovery after Surgery (ERAS) society recommendations in liver surgery and the impact on general and surgery-related complications. 1049 patients who underwent liver surgery from July 2018 to October 2023 were included. The ERAS program strictly followed the official ERAS society recommendations. As a control group (Non-ERAS) 90 patients were treated according to the clinic standard, while 959 patients were treated according within the ERAS measures. After propensity score (PSM) matching 87 Non-ERAS and 258 ERAS patients were analyzed by complications and cumulative sum analysis (CUSUM). ERAS implementation resulted in a significant decrease in general complications (control 27.6% vs. ERAS 16.3%, p = 0.033), largely attributed to a reduction in infection-related complications (control 20.7% vs. ERAS 9.7%, p = 0.007). When examining surgery-related complications no significant disparities were observed (control 17.2% vs. ERAS 17.1%, p = 0.968). The CUSUM analysis of general and non-surgical complications showed that the full effect of the ERAS program only became apparent after several years. Moreover, adherence increased over time consecutively from 62.5 to 72.5% in 4 years. The ERAS society recommendations for liver surgery reduced general complications but did not have any effect on surgery related complications. The effect of the ERAS program progressively improved over the years, highlighting the need for continuous effort to maintain and further enhance outcomes.