Postoperative complications are main reason for noncompliance with enhanced recovery after surgery program in patients undergoing hepatectomy and pancreatectomy

Abstract

Background and Aim Enhanced recovery after surgery (ERAS) protocols are reported to improve postoperative outcomes in patients undergoing a routine protocol and postoperative outcomes in patients undergoing hepatic and pancreatic resections at our institution. Methods A total of 99 consecutive patients at a single institution managed with a similar ERAS protocol were divided into the “early” (50 patients) and “late” (49 patients) cohorts. Both cohorts were statistically identical in demographics and range of surgical procedures performed. Postoperative complications, readmission, reoperation rates, and length of stay were analyzed. Categorical variables were statistically compared using Fisher's exact test and continuous variables using t‐test and Mann–Whitney U‐test when appropriate. Results There were 32 hepatectomies/18 pancreatectomies in the “early” cohort and 22 hepatectomies/29 pancreatectomies in the “late” cohort. The overall complication rate was 38.8%, with a 30‐day readmission rate and reoperation rate of 16.1 and 5%, respectively. There was one mortality (1%). Group‐specific overall complication rate (40 vs 38.7%, P = 0.8), readmission rate (20 vs 12.2%, P = 0.4), reoperation rate (6 vs 4%, P = 1.0), and mortality (2 vs 0%, P = 1.0) were not statistically significant between both groups. Conclusions Despite similar rates of adherence to the established ERAS 24 protocol, there was no improvement in median length of stay (7 days) between the “early” and “late” groups. The only reason for noncompliance with the ERAS protocol was development of surgery‐related complications.

Association between achieving textbook outcomes and better survival after laparoscopic liver resection in the anterolateral segments in patients with hepatocellular carcinoma

“…Several studies have investigated the effects of postoperative complications on long‐term survival after hepatectomy 34 . Postoperative complications are the main reason for noncompliance with enhanced recovery after surgery programs in patients undergoing hepatectomy and pancreatectomy 35 . Enhanced recovery protocols can be safely implemented in hepatectomy, facilitating shorter LOS without increasing morbidity or mortality 36 .…”

“…34 Postoperative complications are the main reason for noncompliance with enhanced recovery after surgery programs in patients undergoing hepatectomy and pancreatectomy. 35 Enhanced recovery protocols can be safely implemented in hepatectomy, facilitating shorter LOS without increasing morbidity or mortality. 36 Taking into account the impact of achieving TO on patient survival, it becomes paramount to develop strategies to improve outcomes.…”

24 Hours or Less Stay After Laparoscopic Minor Hepatectomy

“…All patients were managed with previously described perioperative enhanced recovery after surgery protocol established in our hospital. 2 Laparoscopic resections were carried out using 3-4 ports (5-12 mm) with selective use of hand-port (Gel Port, Applied Medical) insertion for exposure of right posterior section lesions (segment 6 and 7) or when additional retraction was needed. No inflow occlusion was used during any of the cases.…”