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Factors predicting lower hospital stay after liver transplantation using a comprehensive enhanced recovery after
Paola Melgar1, Celia Villodre1, Cándido Alcázar1
1Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, General University Hospital of Alicante Dr. Balmis, Alicante, Spain; Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain; University Miguel Hernandez, Alicante, Spain.
Introduction:
Enhanced recovery after surgery (ERAS) protocols facilitate patient recovery without increasing complication rates. An ERAS protocol designed for our liver transplant (LT) patients obtained a median hospital length of stay (LOS) of 4 days. However, a proportion of patients do not achieve early discharge. This study aimed to identify factors that predict an LOS≤ 4 days.
Methods:
Identifying factors associated with LOS <4 days in our LT patients.
Results:
We performed 293 LTs (2012-2021), LOS≤4 days in 171 (58.4 %). The following factors emerged as statistically predictors of LOS≤4 days in the univariate analysis: male sex, HCC or HCV patients, lower MELD score, lower BAR score, no DCD patients, shorter operative time, no intraoperative transfusion, shorter ICU stay, no Clavien-Dindo complications grade ≥ III, no primary graft dysfunction, no acute rejection, no readmission at 30 days and no retransplantation were associated to LOS≤4 days. However, in the multivariate analysis, the only independent risk factor that predicted LOS≤4 days was the presence of hepatocarcinoma. DCD donors and higher MELD score were negative factors.
Conclusions:
Applying ERAS programs in LT patients is beneficial, safe and extensible to all patients, but those with hepatocarcinoma obtain higher rates of LOS≤4 days.
