Is Current Perioperative Practice in Hepatic Surgery Based on Enhanced Recovery After Surgery (ERAS) Principles?

Abstract

Perioperative care among centers that perform liver resections varied substantially. In current HPB surgical practice, some elements of the ERAS program, e.g., preoperative counselling and minimal fasting, have already been implemented. Elements in the perioperative phase (avoidance of drains and nasogastric tube) and postoperative phase (early resumption of oral intake, early mobilization, and use of recovery criteria) should be further optimized.

Factors associated with failure of enhanced recovery protocol in patients undergoing major hepatobiliary and pancreatic surgery: a retrospective cohort study

“…Our management of patients undergoing HBP surgery incorporated a small proportion of evidence-based components described in ERAS programmes for hepatic4 and pancreatic22 surgery. For every eight patients undergoing major HBP surgery, one was at risk of failing enhanced recovery protocols in major HBP surgery.…”

Fast-Track Programs

“…In order to deepen this issue, a recent report by Wong et al [ 17 ] was developed to assess adhesion to ERAS principles in 11 hepatobiliary centers in Europe: "Compliance" of centers was defi ned according to fulfi llment of 22 ERAS protocol core items. The author observed that the median number of implemented items per center was 9 and compliance was partial in preoperative and perioperative phases, while it was still poor during postoperative course, so they concluded that implementation of fasttrack protocols is desirable in order to standardize care and improve recovery after surgery even further, but it requires multidisciplinary efforts.…”

A commentary on “Red blood cell transfusion practice in elective liver resection: Single center scenario” by Dr Andreas Vogt

“…Harmonization and implementation of multimodal enhanced recovery programs in liver surgery [8] might further improve patient care and validity of prospective (single-multicentre) observational clinical studies.…”

“…Reduced preoperative red blood cell count was reported as an independent risk factor for 80-months mortality in 758 patients undergoing hepatic resection for primary liver cancer [7]. Backbleeding during laparoscopic liver surgery might be well controlled by a CO 2 pneumoperitoneum at 10e14 mmHg and a central venous pressure at <5 mmHg [2,8].…”

“…Reduced preoperative red blood cell count was reported as an independent risk factor for 80-months mortality in 758 patients undergoing hepatic resection for primary liver cancer [7]. Backbleeding during laparoscopic liver surgery might be well controlled by a CO 2 pneumoperitoneum at 10e14 mmHg and a central venous pressure at <5 mmHg [2,8].Kingham et al reported a shift from cardio-pulmonary complications to abdominal infections over the last decades [1]. Perioperative transfusion, major hepatectomy and peak postoperative bilirubin were independent predictors of postoperative morbidity.…”