Impact of 2016 enhanced recovery after surgery (ERAS) recommendations on outcomes after hepatectomy in cirrhotic and non-cirrhotic patients

Abstract

Introduction: The Enhanced Recovery After Surgery (ERAS) society published new recommendations for hepatectomy in 2016. Few studies have assessed their clinical impact. The aim of this monocentric study was to assess the impact of those guidelines on liver surgery with a special focus on cirrhotic patients. Method: Postoperative outcomes of patients undergoing hepatectomy 30 months before and after ERAS implementation according to the 2016 ERAS guidelines were compared after inverse probability of treatment weighting (IPTW). Primary endpoint was 90-day morbidity. Results: From 2015 to 2020, 430 patients underwent hepatectomy including 226 procedures performed before and 204 after ERAS implementation. After IPTW, overall morbidity (42.5% vs 64.7%, p<0.001), Comprehensive Complication Index (CCI) score (14.3 vs 20.8, p=0.004), length of stay (10.4 vs 13.7 days, p=0.001) and textbook outcome (40.2% vs 50%, p=0.022) were significantly improved in ERAS group, while mortality and severe complications were similar in both groups. In the non-cirrhosis subgroup these results were confirmed. However, in the cirrhosis subgroup, no difference appeared on outcomes after hepatectomy with an overall morbidity (47.5% vs 65.2%, p=0.069) and a length of stay (8 vs 9 days, p=0.310) which were not significantly different. Conclusion: Perioperative ERAS program for hepatectomy results in improved outcomes with decreased rate of non-severe morbidity. Although those guidelines are not deleterious in cirrhotic patients, they probably require revision to be more effective in this patient population.