title: Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection.
abstract: BACKGROUND
  Accelerated recovery from surgery has been achieved when patients are managed within a multimodal Enhanced Recovery After Surgery (ERAS) protocol. This study evaluated the benefit of an ERAS programme for patients undergoing liver resection.
  
  
  METHODS
  The ERAS protocol of epidural analgesia, early oral intake and early mobilization was studied prospectively in a consecutive series of 61 patients. Outcomes were compared with those in a consecutive series of 100 patients who underwent liver resection before the start of the study. Endpoints were postoperative length of hospital stay, postoperative resumption of oral intake, readmissions, morbidity and mortality.
  
  
  RESULTS
  Fifty-six patients (92 per cent) in the ERAS group tolerated fluids within 4 h of surgery and a normal diet on day 1 after surgery. Median hospital stay, including readmissions, was 6.0 days compared with 8.0 days in the control group (P < 0.001). There were no significant differences in rates of readmission (13 and 10.0 per cent respectively), morbidity (41 and 31.0 per cent) and mortality (0 and 2.0 per cent) between ERAS and control groups.
  
  
  CONCLUSIONS
  The ERAS fast-track protocol is safe and effective for patients undergoing liver resection. It allows early oral intake, promotes faster postoperative recovery and reduces hospital stay.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. rvdm@surgery.azm.nl
authors.forename: R M
authors.initials: RM
authors.lastname: van Dam
authors.forename: P O
authors.initials: PO
authors.lastname: Hendry
authors.forename: M M E
authors.initials: MM
authors.lastname: Coolsen
authors.forename: M H A
authors.initials: MH
authors.lastname: Bemelmans
authors.forename: K
authors.initials: K
authors.lastname: Lassen
authors.forename: A
authors.initials: A
authors.lastname: Revhaug
authors.forename: K C H
authors.initials: KC
authors.lastname: Fearon
authors.forename: O J
authors.initials: OJ
authors.lastname: Garden
authors.forename: C H C
authors.initials: CH
authors.lastname: Dejong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002985:Clinical Protocols; D004434:Early Ambulation / Q000706:statistics & numerical data; D004435:Eating / Q000502:physiology; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D020127:Recovery of Function