Effects of multimodal fast-track surgery on liver transplantation outcomes

Effects of multimodal fast-track surgery on liver transplantation outcomes

Rao JH, Zhang F, Lu H, Dai XZ, Zhang CY, Qian XF, Wang XH, Lu L. Hepatobiliary Pancreat Dis Int. 2017 Aug 15;16(4):364-369

What is already known:

Originally starting with colorectal surgery, ERAS protocols now exist for a huge number of different specialities and procedures. Liver transplantation is one the latest to be added to this list.

What this paper adds:

ERAS society guidelines currently don’t exist for liver transplantation, so the authors wrote their own. They stuck to the essential elements of preoperative education, minimising hypothermia, avoiding surgical drains, early extubation, early mobilisation and early enteral nutrition. The authors conducted a single-blinded randomised controlled trial. It is unclear who exactly is blinded but there is a suggestion it could be the patient. 128 patients were randomised over a two year period, into their new fast-tract protocol or their normal standard care. They demonstrated an impressive reduction in their ICU length of stay and hospital length of stay (5 days to 2 days, and from 28 days to 18 days). However there were no difference in complications, readmissions or mortality. Suggesting that at the very least an ERAS pathway for liver transplantation is feasible and safe.

Chris Jones, Guildford. @chrisnjones