Liver Transplant Fast-Track With an Emphasis on Reduced Delirium: A Multidisciplinary Approach to Reducing Length of...

Area of Science:

• Transplantation Medicine
• Surgical Protocols
• Patient Recovery

Background:

• Enhanced recovery after surgery (ERAS) protocols aim to optimize patient outcomes and reduce healthcare resource utilization.
• Liver transplant recipients (LTR) often experience prolonged hospital stays and complications like delirium.

Purpose of the Study:

• To evaluate the impact of a standardized Fast Track protocol on length of stay (LOS) and delirium in liver transplant recipients.
• To assess the feasibility and safety of implementing an ERAS protocol in a high-acuity LTR population.

Main Methods:

• A standardized Fast Track protocol was implemented, including reduced intraoperative corticosteroids, once-daily steroid tapers, early extubation, multimodal analgesia, early drain removal, and enhanced patient/provider education.
• The study compared outcomes between LTRs before and after protocol implementation.
• Primary outcome was post-liver transplant (LT) LOS; secondary outcomes included delirium incidence, ICU LOS, rejection rates, and readmission rates.

Main Results:

• Median LOS decreased from 12 days (pre-implementation) to 10 days (post-implementation) (p=0.025).
• The incidence of delirium significantly reduced from 25.8% to 8.6% (p=0.013).
• No significant differences were observed in ICU LOS, rejection rates, or readmission rates between the groups.

Conclusions:

• Implementation of a Fast Track protocol is feasible and safe in high-acuity liver transplant recipients.
• The protocol is associated with a significant reduction in length of stay and delirium incidence.
• This ERAS approach can optimize recovery and resource utilization in liver transplantation.