Nonstrict and individual enhanced recovery after surgery (ERAS) in partial hepatectomy

SpringerPlus, Dec 2016

Background We aimed to evaluate postoperative recovery and short-term outcomes of patients undergoing partial hepatectomy managed with a nonstrict and individual enhanced recovery after surgery (ERAS) program. Methods A retrospective analysis of 168 partial hepatectomy patients in our institution was included. The discharged day and the respective impact of element application throughout the duration were analyzed. Results When all the required elements of ERAS were fully implemented, the median discharge day was 6. The more deviation occurred, the more delayed the patient discharged (P < 0.01). Preoperative ASA score, basic conditions of patients and ages were revealed closely associated with discharge day (P < 0.001). Without or an early removal of tubes and early oral feeding reduced hospital stay statistically (P < 0.01). Early discharge of patients (<3 days) did not show an increased complication incidence or readmission (P > 0.05). Conclusion Nonstrict and individual use of ERAS in partial hepatectomy reduced postoperative length of stay without increasing complication rate. Our study proposes a modulation of ERAS according to the needs and acceptance of patients. In a word, better optionally required rather than mandatorily meet.

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Nonstrict and individual enhanced recovery after surgery (ERAS) in partial hepatectomy

Xu et al. SpringerPlus Nonstrict and individual enhanced recovery after surgery (ERAS) in partial hepatectomy Xingwei Xu 0 2 Yingbin Wang 1 Tao Feng 0 2 Xin Zhao 0 2 Yannian Liao 0 2 Wu Ji 0 2 Jieshou Li 0 2 0 Jinling Hospital, Research Institute of General Surgery, Nanjing University, School of Medicine , Nanjing 210002, Jiangsu Province , People's Republic of China 1 General Surgery, General Hospital of Tisco Affiliated to Shanxi Medi- cal University , Taiyuan 030008, Shanxi Province , People's Republic of China 2 Jinling Hospital, Research Institute of General Surgery, Nanjing University, School of Medicine , Nanjing 210002, Jiangsu Province , People's Republic of China Background: We aimed to evaluate postoperative recovery and short-term outcomes of patients undergoing partial hepatectomy managed with a nonstrict and individual enhanced recovery after surgery (ERAS) program. Methods: A retrospective analysis of 168 partial hepatectomy patients in our institution was included. The discharged day and the respective impact of element application throughout the duration were analyzed. Results: When all the required elements of ERAS were fully implemented, the median discharge day was 6. The more deviation occurred, the more delayed the patient discharged (P < 0.01). Preoperative ASA score, basic conditions of patients and ages were revealed closely associated with discharge day (P < 0.001). Without or an early removal of tubes and early oral feeding reduced hospital stay statistically (P < 0.01). Early discharge of patients (<3 days) did not show an increased complication incidence or readmission (P > 0.05). Conclusion: Nonstrict and individual use of ERAS in partial hepatectomy reduced postoperative length of stay without increasing complication rate. Our study proposes a modulation of ERAS according to the needs and acceptance of patients. In a word, better optionally required rather than mandatorily meet. Nonstrict; Individual; ERAS; Discharge - Background The concept of enhanced recovery after surgery (ERAS) was first introduced in colorectal surgery 15  years ago. Since then, ERAS strategy has been applied and adopted successful in other specialties areas, including urology, vascular and orthopedic surgery. ERAS refers to combining multimodal pathway including anesthesia, surgical, nursing and perioperative management to accelerate recovery, preserve body composition, and shorten discharge time without affecting morbidity. It also improves efficiency of hospital beds use and a decrease of hospital cost (Kim et al. 2012; Gouvas et al. 2009; French et al. 2009; Bosio et al. 2007). Partial hepatectomy is still the most common treatment for liver tumor, and there are some non-randomized studies showing that ERAS significantly reduces length of hospital stay, lowers complication rates, and cuts total costs without any increase in mortality or readmission (Schultz et  al. 2013; Hughes and McNally 2014). Neverless, major morbidity ranges from 17% in benign to 27% in malignant disease, with a mortality risk of up to 5%. The reality we found in clinical is that most patients could rarely often strictly meet all the elements of ERAS, while a strict ERAS requires high standards for clinical team and stringent inclusion criteria of the patients. Therefore, not attainable in every institution (Connor et  al. 2013). Therefore, to verify whether a nonstrict and individual ERAS is feasible in patients of partial hepatectomy, we have decided to take this retrospective study to compare the shortterm outcomes. © The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Patients and methods Trial design From January 2014 to July 2015, all patients between the ages of 16 and 75 years who underwent partial hepatectomy by laparoscopic procedures for liver cancer at the Department of Surgery, Jinling Hospital were considered to be included into the study. The inclusion criteria were: (1) elective partial hepatectomy for liver cancer or tumor; (2) no major concomitant surgical procedures, such as bowl, gastro or bile duct resection; (3) tumors either in the right or left hemiliver with the extent of partial hepatectomy being a hemihepatectomy or less; (4) Child–Pugh A/B liver function status; (5) without severe contraindications that not suited for ERAS (such as anticoagulant therapy). Hepatectomy were all carried out by the same team of surgeons who had an experience of over 2000 hepatic resections. The study protocol was approved by the Ethics Committee of Jinling Hospital and Nanjing University. All clinical investigation has been conducted according to the principl (...truncated)


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Xingwei Xu, Yingbin Wang, Tao Feng, Xin Zhao, Yannian Liao, Wu Ji, Jieshou Li. Nonstrict and individual enhanced recovery after surgery (ERAS) in partial hepatectomy, SpringerPlus, 2016, pp. 2011, Volume 5, Issue 1, DOI: 10.1186/s40064-016-3688-x