Short-term outcomes after implementation of ERAS in liver surgery

Abstract

Introduction: Enhanced recovery pathways have previously proven to reduce length of hospital stay (LOS) in many types of surgeries. Their use in liver surgery remains limited and formal guidelines have not been published. Methods: Using our institutional NSQIP data, we conducted a retrospective review of patients who underwent hepatectomies from 2013-2017. The liver ERAS program was implemented in 2015. Subjects were stratified into two categories: before and after ERAS. The primary outcome was LOS after surgery. Secondary outcomes included postoperative infection, transfusion, liver failure, UTI, sepsis, and readmission. Categorical variables were compared using Fischer exact or Pearson Chi-Square test. LOS was compared using Mann-Whitney U test. Statistical significance was defined as p value < 0.05. Results: 101 patients underwent major hepatectomies (52 traditional and 49 ERAS cases) and 288 patients underwent minor hepatectomies (186 traditional and 102 ERAS cases). There was no significant difference in LOS following major hepatectomy after implementation of ERAS (6.5 vs. 6 days, p=0.25). There was an increase in the rate of postoperative liver failure (3.8% vs. 14.3%, p=0.09). In contrast, there was a significant decrease in LOS for patients undergoing minor liver resection after the implementation of ERAS (5 vs. 3 days, p=0.008) with no difference in secondary outcomes. Conclusion: The implementation of a liver ERAS pathway notably decreased LOS for minor hepatectomies. We suspect that the higher rate of liver failure and unchanged LOS for major liver resections is likely due to increase case complexity and more aggressive oncologic resections.