Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy

Yang R, Tao W, Chen YY, Zhang BH, Tang JM, Zhong S, Chen XX. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: A meta-analysis. Int J Surg. 2016 Dec;36(Pt A):274-282.

What is already known:

Multiple published trials, including a recent meta-analysis (Song et al 2016) have highlighted the benefits of implementing ERAS programs in patients undergoing open hepatectomy. However, with an increasing number of centers now moving towards a laparoscopic approach the evidence for using such programs within this cohort is less well established.

What this paper adds:

This meta-analysis, which includes 8 studies (3RCT and 5CCT), showed no significant difference when applying ERAS principles to intra-operative complications including blood loss, blood transfusion requirement and intra-operative surgical time. There was however a significant improvement in post-operative recovery with a reduced time to first oral intake, flatus and a decreased post-operative stay and complication rate. Re-admission rates were not analysed due to the lack of data in the reviewed studies and variance in study protocols.

Further studies may be required to determine the optimal ERAS protocol for patients undergoing a laparoscopic hepatectomy.

Emma Stewart, Guildford.


Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection

Clark CJ, Ali SM, Zaydfudim V, Jacob AK, Nagorney DM. Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection. PLoS One. 2016 Mar 7;11(3):e0150782.

What is already known:

There are several published studies relating to ERAS for open liver resection and a recent meta-analysis (Zhao et. al. 2017) demonstrated reduced hospital length of stay, time to first flatus and complications following implementation of an ERAS programme.

What this paper adds:

This retrospective observational cohort study did not demonstrate improvements in hospital length of stay or complication rates as others looking into ERAS for open liver resection have done. The study suggested that complication rates and ICU admissions were lower, albeit not statistically significant. The primary conclusion was that ERP implementation was safe in open liver resection. The study was limited to a single-surgeon and did not monitor compliance to the ERP protocol.

Ben Morrison, Guildford.


Outcomes after ERAS for liver resection surgery

Hughes MJ, Chong J, Harrison E, Wigmore S. Short-term outcomes after liver resection for malignant and benign disease in theage of ERAS. HPB (Oxford). 2016 Feb;18(2):177-82.

What is already known:

Predictors of postoperative morbidity have been studied at length over the years but there is less evidence for predictors of morbidity in patients undergoing ERAS programmes.

What this paper adds:

This is a retrospective study in a unit that is experienced in ERAS for liver surgery. In over 600 patients, using univariate and multivariate analysis, they found that only extended (liver) resection was a predictor of morbidity within an ERAS program for open liver resection surgery.

Chris Jones, Guildford.


How does implementing an ERAS program in one speciality affect other specialities?

Labgaa I, Jarrar G, Joliat GR, Allemann P, Gander S, Blanc C, Hübner M, Demartines N. Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a PositiveImpact on Non-ERAS Liver Surgery Patients. World J Surg. 2016 May;40(5):1082-91.

What is already known:

The majority of ERAS studies only look at the outcomes of the individual speciality being examined. This looks at the impact on different specialities undergoing different operations but being looked after on the same post-operative ward.

What this paper adds:

In this retrospective Swiss paper, a colorectal ERAS programme was introduced (but not for liver resection patients), and outcomes of all patients compared before the introduction of an official liver ERAS programme. Overall complication rates did not change but major complications were significantly reduced. Length of stay was reduced by 2 days without increasing readmission rates.

It demonstrates that a successful ERAS program in one speciality can have unintended benefits in other unrelated specialities, presumably by a Hawthorne type effect.

Chris Jones, Guildford.