Enhanced recovery after liver surgery: A comparative study of a Southern Brazilian center

Abstract

Objectives: After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. On August 2016, the official protocol of ERAS Society for Liver Surgery was published. Since then, msany institutions all over the world have shown favorable outcomes after the implementation of these guidelines. This work represents the first Brazilian experience regarding hepatic surgery. Methods: 50 patients that underwent elective hepatic surgery at Santa Casa Hospital were retrospectively evaluated, using medical records data, from June 2014 to July 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. Groups were compared using Mann-Whitney and Student's t-test (for normal distribution), and statistical analysis was performed through the chi-square test of homogeneity with a level of significance of 5%. Results: There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by 2 days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilisation were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, subcostal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. Conclusion: Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.