A systematic review of outcomes in patients undergoing liver surgery in an enhanced recovery after surgery pathways

Coolsen, Mariëlle M.E.; Wong-Lun-Hing, Edgar M.; Dam, Ronald M. van; Wilt, A. A. van der; Slim, K.; Lassen, Kristoffer; Dejong, Cornelis H. C.

doi:10.1111/j.1477-2574.2012.00572.x

Cited by 127 publications

(118 citation statements)

References 31 publications

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“…Two systematic reviews showed a decrease in complications and/or a reduction of LoS without an increase of the readmission rate, corroborating the results of this present study [18,19]. A study by Dunne et al including hepatectomies for colorectal metastasis found that as ERAS experience increases with time, a progressive diminution of hospitalization time and critical care admission was noticed [30].…”

Section: Discussionsupporting

confidence: 90%

Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery

et al. 2016

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Section: Discussionsupporting

confidence: 90%

Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery

et al. 2016

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“…In an effort to clarify the role of FT programs in liver resection, Coolsen and colleagues published a systematic review of two randomized controlled trials (RCTs), three case-control studies and one retrospective case series [14]. They demonstrated that FT programs reduced the length of hospital stay without compromising morbidity, mortality, or readmission rates in liver resection.…”

Section: Introductionmentioning

confidence: 99%

Fast-Track Programs Versus Traditional Care in Hepatectomy: A Meta-Analysis of Randomized Controlled Trials

Lei

Wang²,

Tan³

et al. 2014

Dig Surg

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Background/Aims: The role of fast-track programs in hepatectomy is unclear. This meta-analysis aimed to evaluate the efficacy and safety of fast-track programs versus traditional care. Methods: We searched Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar for relevant randomized controlled trials (RCTs) comparing fast-track with traditional care in hepatectomy. Length of hospital stay, time to first flatus, postoperative complications, operating time, and intraoperative blood loss were assessed. Meta-analyses were performed using RevMan 5.2 software. Results: Four original RCTs with 372 patients were included: 187 in the fast-track and 185 in the traditional care group. Fast-track patients had shorter hospital stay (WMD -2.32; 95% CI, -3.54 to -1.11; p < 0.001) and time to first flatus (WMD -0.99; 95% CI, -1.15 to -0.84; p < 0.001), and less postoperative complications (RR 0.66; 95% CI, 0.47 to 0.93; p < 0.05). However, there was significant heterogeneity between the studies regarding hospital stay (I² = 88%; p < 0.001). Operating time and intraoperative blood loss were not different. Conclusions: Patients in fast-track programs had less time to first flatus and postoperative complications compared to traditional care. Fast-track programs may reduce the length of hospital stay. Larger, higher quality prospective RCTs are necessary to draw more robust conclusions.

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“…Published guidelines from the ERAS Society cover recommendations for perioperative care, not only for colorectal surgery [3,4] , but also pancreaticoduodenectomy [15] and radical cystectomy for bladder cancer [16] . In addition, enhanced recovery protocols have safely and successfully been implemented for other major elective abdominal procedures such as liver resections [17] , esophagectomy [18,19] , gastrectomy [20] , bariatric surgery [21] , hysterectomy [22] , and emergency surgery [23,24] .…”

Section: Surgical Disciplinesmentioning

confidence: 99%

Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

Segelman

Nygren

2014

WJG

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Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient-and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Enhanced recovery; Surgery; Fast track; Perioperative management; Postoperative outcomeCore tip: There is a strong and evolving evidence base to support Enhanced Recovery After Surgery (ERAS) programs in abdominal surgery. Such pathways are safe and efficient in enhancing recovery and reducing morbidity. However, patient-related outcomes, cost effectiveness and long-term benefits from ERAS protocols need to be studied more carefully in the future. To support efficient and successful implementation, further educational efforts have to be performed on a national or regional level to improve the standard of care in the general population.

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A systematic review of outcomes in patients undergoing liver surgery in an enhanced recovery after surgery pathways

Abstract: This systematic review suggests that ERAS protocols can be successfully implemented in liver surgery. Length of stay is reduced without compromising morbidity, mortality or readmission rates.

Cited by 127 publications

References 31 publications

Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery

Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery

Fast-Track Programs Versus Traditional Care in Hepatectomy: A Meta-Analysis of Randomized Controlled Trials

Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

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