Abstract
ABSTRACTBackground: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. Aim:To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. Methods: Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. 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 two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal 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.
Highlights
Since the publication of the first enhanced recovery after surgery (ERAS) guidelines regarding colonic resections by Gustafsson et al in 201216, the proposal of reduction of surgical stress, maintenance of physiological functions and optimized recovery quickly gained the attention of the international medical community
A significant number of patients completed the preoperative fasting protocol in ERAS group (70%), and carbohydrate loading with maltodextrin in 80% of them (p
Prophylactic abdominal drainage was less common in ERAS group comparing with control (68.6% and 92%, p=0.012)
Summary
Since the publication of the first enhanced recovery after surgery (ERAS) guidelines regarding colonic resections by Gustafsson et al in 201216, the proposal of reduction of surgical stress, maintenance of physiological functions and optimized recovery quickly gained the attention of the international medical community. Despite significant improvements in perioperative management and surgical technique, which led to a reduction in postoperative mortality to less than 5%, major hepatectomies still have a morbidity rate up to 30% in some reports[9,10,11]. This way, the implementation of evidenced-based recommendations in order to optimize perioperative recovery can greatly benefit patients and health providers[3]
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