Impact of 2016 Enhanced Recovery after Surgery (ERAS) Recommendations on Outcomes after Hepatectomy

Abstract

Introduction: The Enhanced Recovery After Surgery (ERAS) society published new recommendations for hepatectomy in 2016. Yet, no studies have formerly assessed its impact. The aim of the present study was to assess the impact of 2016 ERAS new guidelines on hepatectomy outcomes at a tertiary center. Method: Postoperative outcomes of patients undergoing hepatectomy 18 months before and after ERAS implementation according to the 2016 guidelines were compared after propensity-score matching (PSM). Primary endpoint was 90-day morbidity and mortality. Results: From 2016 to 2019 288 patients underwent hepatectomy including 141 procedures performed before and 147 after ERAS implementation. Before PSM, ERAS patients had an older age (66 vs. 62 years, p=0.01), higher ASA score (p=0.01), more cirrhosis (26% vs. 16%, p=0.03), and less laparoscopic procedures (31% vs. 47%). After PSM, both groups became well-balanced for all baseline variables. Median CCI score (0 vs. 21, p=0.02) and overall morbidity (41% vs. 64%, p< 0.001) were lower in the ERAS group, which was due to a higher rate of medical (Clavien grade 2) complications in the control group (35% vs. 15%, p=0.001). Blood loss (350 vs. 400 ml, p=0.67), operative time (235 vs. 240 min, p=0.61), 90-day mortality (4.5% vs. 3.6%, p=1.00), severe postoperative morbidity (18% vs. 22%, p=0.49), hospital stay (8 vs. 9 days, p=0.34) and readmission rate (10% vs. 7.3%, p=0.64) were similar between the 2 groups. Conclusion: Perioperative ERAS program for hepatectomy results in improved outcomes due to a decreased rate of medical postoperative morbidity.