Abstract
The enhanced recovery after surgery (ERAS) program aims to attenuate the surgical stress response and decrease postoperative complications. It has increasingly replaced conventional approaches in surgical care. To evaluate the benefits and harms of the ERAS program compared to conventional care in patients undergoing liver surgery. We searched the MEDLINE, PubMed, EMBASE and Cochrane databases. All RCTs that compared the ERAS program with conventional care were selected. Four RCTs were eligible for analysis, which included 634 patients (309 ERAS vs. 325 conventional). Overall morbidity (RR 0.67; 95 % CI 0.48–0.92; p = 0.01), primary length of stay (WMD −2.71; 95 % CI −3.43 to −1.99; p < 0.00001), total length of stay (WMD −2.10; 95 % CI −3.96 to −0.24; p = 0.03), time of functional recovery (WMD −2.30; 95 % CI −3.77 to −0.83; p = 0.002), and time to first flatus (SMD, −0.52; 95 % CI −0.69 to −0.35; p < 0.00001) were significantly shortened in the ERAS group. Quality of life was also better in the ERAS group. However, no significant differences were noted in mortality, readmission rates, operative time and intraoperative blood loss. The ERAS Program for liver surgery significantly reduced overall morbidity rates, accelerated functional recovery, and shortened the primary and total hospital stay without compromising readmission rates. Therefore, ERAS appears to be safe and effective. However, the conclusions are limited because of the low methodological quality of the analyzed studies. Further studies are needed to provide more solid evidence.
Highlights
Liver resection refers to the removal of a portion of the liver
This paper evaluates the beneficial and harmful effects of Enhanced recovery after surgery (ERAS) programs compared to conventional care in patients undergoing liver surgery
Search results In total, 838 records were retrieved from the initial literature search
Summary
Liver resection refers to the removal of a portion of the liver. Liver resection has long been considered a major abdominal surgery and is associated with high morbidity and mortality. Enhanced recovery after surgery (ERAS) or Fast track surgery (FTS), a new perioperative care, was developed to improve surgical outcomes and has gradually replaced conventional approaches in surgical care. According to the recommendations of the ERAS working group, ERAS programs consist of 17 different items, including preoperative, perioperative and postoperative measures. Techniques include preoperative counseling and feeding, epidural anesthesia, minimally invasive incisions, optimal pain control, fluid overload prevention, no routine use of drains, and aggressive postoperative rehabilitation (Lassen et al 2009).
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