Impact of enhanced recovery after surgery on open and laparoscopic liver surgery: A single center cohort study.

A Moekotte,F Giovinazzo,C Kuemmerli,A Rawashdeh,H Clarke,A Al Jaiuossi,M Alzoubi,J Primrose,A Takhar,T Armstrong,Z Hamady,M Abu Hilal

doi:10.1016/j.hpb.2020.04.492

A Moekotte, F Giovinazzo + Show 10 more

Open Access

https://doi.org/10.1016/j.hpb.2020.04.492

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Abstract

Background: Enhanced recovery after surgery (ERAS) protocols are designed to improve postoperative recovery. ERAS has shown to reduce hospital stay and improve post operative outcomes. The aim of this study is to investigate the impact of ERAS on liver surgery and assess whether impact differs when applied in laparoscopic vs open liver surgery. Methods: All liver resections performed in a single center, between January, 1 2008 and December 31, 2016 were identified and clinical data were collected. ERAS was implemented in May 2013 and carried out throughout the study period. Patients treated according to ERAS were compared with patients treated before implementation of ERAS. The primary endpoint was hospital stay. Multivariable linear regression was performed to account for confounders. Results: Overall, 787 patients were included (375 ERAS and 412 pre-ERAS). The mean age was 64±14 years and 415 (53%) were female. A total of 405 (52%) resections were considered major and 439 (56%) of the entire cohort were performed laparoscopically. Hospital stay was shorter after implementation of ERAS in t open liver surgery (7 (5-9) days vs 7 (6-12) days in ERAS and pre-ERAS, respectively, P=0.006). This difference was not seen in laparoscopic resections. In multivariable analysis both ERAS (β= -0.88, P=0.03) and the laparoscopic approach (β= -3.74, P<0.001) were independently associated with a shorter hospital stay. Sensitivity analysis of the subgroups open and laparoscopic surgery revealed that the impact of ERAS on hospital stay was seen in open liver surgery (β= -2.75, P=0.003) but not in laparoscopic liver surgery (β= 0.25, P=0.44). Conclusions: As in other surgical fields, ERAS reduces hospital stay in liver surgery. However, the impact is only seen in open liver surgery. It is possible that the laparoscopic approach itself, leading to a reduced surgical insult, has a greater impact on hospital stay than ERAS.

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