Fast-Track Recovery Program After Major Liver Resection

Abstract

The objective of this study was to compare fast-track (FT) recovery protocol with the conventional one in patients treated with major liver resection by evaluating perioperative morbidity, length of hospitalization, and readmission rate. Sixty-two patients suffering from malignant liver tumors were surgically treated from May 2012 to April 2014. After randomization, they were prospectively divided into two groups: Group A patients (n = 32) followed FT recovery protocol and Group B patients (n = 30) were treated with the conventional (CON) protocol. Postoperative morbidity, readmission rate, and median hospital stay in the two groups were studied. Fast-track protocol was associated with a decreased complication (25%, p = .002), whereas the risk of postoperative morbidity was 2.4 times higher in patients treated with the CON protocol (60%, p = .002). Readmission rate was not significantly different between the two groups (6.25%, p = .35). Age (p = .382) and body mass index (p = .818) were not a suspending factor for following the FT protocol. Overall length of stay (postoperative days) in the FT group was (mean ± SD) 5.75 ± .5 and in the CON group was 13.5 ± 6.7 (p < .001). Fast-track recovery protocol seems to be safe and particularly efficient in patients undergoing major liver resections.

<p>Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review</p>

“…107 Two studies focused on adolescents, 22 , 37 and one study included both adults and children. 84 Although older adults (>75 years) were included in some studies 52 , 60 , 62 they were not specifically identified as the target population in any of the included studies.…”

“…Over half of studies involved interventions that were delivered during the preoperative phase of care (n=41, 48%); 13 studies delivered interventions during the intraoperative phase (n = 13, 15%); 24 , 26 , 31 , 43 , 46 , 51 , 74 , 75 , 86 , 92 , 97 , 99 , 101 13 studies (15%) delivered interventions solely in the postoperative phase, 36 , 39 , 44 , 47 , 48 , 60 , 66 , 68 , 73 , 77 , 82 , 90 , 107 Supplementary file 3 ; eight studies (9%) were based on interventions that were delivered during multiple phases of the perioperative pathway. 34 , 35 , 42 , 56 , 61 , 76 , 85 , 96 Almost half of the included studies assessed outcomes at multiple phases of the perioperative pathway (n = 34, 40%), whilst 24 studies (28%) assessed postoperative outcomes extending beyond the immediate PACU phase.…”

“…Postoperative pain relief was the third most common primary outcome of interest (n=13, 15% of included studies), 22,24,31,34,36,41,50,51,55,62,65,72,92 and a secondary outcome in 13 studies (15%). 35,40,47,52,60,69,75,76,79,81,86,87 Interventions of interest in the studies where pain was the primary outcome included hypnosis; 55 anaesthetic technique (for hysteroscopy); 51 play; 72 Reiki; 34 premedication and information; 50 different routes of paracetamol administration; 41,62 cold application; 65 guided imagery and relaxation; 22 positioning and early sandbag removal (post-coronary angiography); 92 room air versus carbon dioxide (CO 2 ) insufflation; 24,31 and bed positioning. 36 Nine studies had adult participants, 31,34,36,41,50,51,62,65,92 two were pediatric based, 55,72 and one study focused on adolescents.…”

“…23,107 Other Clinical Outcomes A wide variety of other clinical practices were investigated as primary outcomes in the identified RCTs (Supplementary file 3). 25,27,28,30,33,45,47,52,60,68,75,77,78,95,101,102…”

Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

“…Additionally, it is important to note a growing number of recently published trials, including randomized prospective studies, that confirm there is a place for ERAS in this surgical discipline. Although mentioned trials do not have an overwhelming number of subjects (62 patients in Kapritsou et al study [ 36 ]; 160 in Qi et al RCT [ 37 ]), they provide strong evidence of clinical safety and efficacy, even in major resections.…”