Impact of 2016 Enhanced Recovery After Surgery (ERAS) Recommendations on Outcomes after Hepatectomy in Cirrhotic and Non-Cirrhotic Patients

Impact of 2016 Enhanced Recovery After Surgery (ERAS) Recommendations on Outcomes after Hepatectomy in Cirrhotic and Non-Cirrhotic Patients

Thibault Lunel et al. World J Surg. 2021 (6)

What is already known:

ERAS has been shown to be safe and to improve outcomes in liver surgery (1,2). Several studies and meta-analyses have shown that ERAS in liver surgery allowed decreasing postoperative complications, length of stay, and costs (3-5).

What this paper adds:

This cross-sectional study compared ERAS management vs. non-ERAS management (historical control group before ERAS implementation) in liver surgery patients. After inverse probability of treatment weighting, the authors confirmed previous findings in non-cirrhotic patients (improved Comprehensive Complication Index, length of stay, and textbook outcomes with ERAS). The other interesting finding was that postoperative outcomes were not different between ERAS and non-ERAS patients in the subgroup of cirrhotic patients. Of note, the cirrhosis subgroup was rather small (n=59 ERAS, n=46 non-ERAS) and the compliance rate to ERAS guidelines was lower than recommended (60%). ERAS in cirrhotic patients needs further investigation.