Enhanced Recovery (Eras) After Liver Surgery:comparative Study in a Brazilian Terciary Center

Abstract

Background:After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. Aim:To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. Methods: Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. Results:There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. Conclusion: Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.

Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

“…There were significant variations in the number of elements utilized in each study. All studies applied 19 items or less with the exemption of Teixeira et al 40 that implemented the 23 elements as recommended in the current ERAS guidelines. 5 The reason for this could be that ERAS protocols were implemented in these studies after the current guidelines were published.…”

“…One way of measuring and monitoring compliance within ERAS programme is through systematic audit. 5 However, only 18.5% (5/27) of the included studies reported performing a systematic audit 20,24,27,28,40 to monitor of ERAS elements within the ERAS programme.…”

“…Three of the four studies measured overall compliance to ERAS elements. 24,27,40 Compliance was higher in the ERAS group across the three studies, ranging from 65% to 73.8% in the ERAS group and 20% to 48.7% in the standard group. Jones et al 25 reported 100% compliance in 18 out of the 19 ERAS elements in the ERAS group compared to 100% in 11 out the 19 ERAS elements in the standard care group.…”

Factors Related to the Reduction of the Risk of Complications in Colorectal Surgery Within Perioperative Care Recommended by the Acerto Protocol

“…This was named Projeto ACERTO (acronym in portuguese for “Aceleração da Recuperação Total” no Pós-Operatório - Enhancing total postoperative recovery). As ERAS (Enhanced Recovery After Surgery) 25 , 26 , 28 , the ACERTO protocol is based in a solid reference of studies that have shown the benefit of the evidence applied to surgery can positively alter results such as early recovery of organ function, reduced days of hospitalization, decrease postoperative complications and death 3 , 6 , 9 . In a large prospective study with 5,974 elective patients, the same authors compared outcomes before and after the implementation of the ACERTO protocol.…”

Impact of the Enhanced Recovery Program after Hepato-Pancreato-Biliary Surgery

“…In a Brazilian tertiary center, Teixeira et al showed that patients in the ERAS group after hepatectomy were discharged 2 days earlier than those in the control group ( P < 0.001). [9] In 2019, Chong et al reported shorter LOS ( P = 0.033) with ERAS, without any increase in complication rates. Patients were discharged at least 1–10 days earlier.…”