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
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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
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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)