title: Evaluation of a fast-track programme for patients undergoing liver resection.
abstract: BACKGROUND
  Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and to decrease morbidity and hospital stay for several major surgical procedures. The aim of this study was to investigate the effect of introducing fast-track principles for perioperative care in unselected patients undergoing open or laparoscopic liver resection.
  
  
  METHODS
  This was a prospective study involving the first 100 consecutive patients who followed fast-track principles for liver resection. Catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. Discharge criteria were: pain sufficiently controlled by oral analgesics alone, patient comfortable with discharge and no untreated complications.
  
  
  RESULTS
  Median length of stay (LOS) for all patients was 5 days, with 2 days after laparoscopic versus 5 days following open resection (P < 0·001). Median LOS after minor open resections (fewer than 3 segments) was 5 days versus 6 days for major resections (3 or more segments) (P < 0·001). Simple right or left hemihepatectomies had a median LOS of 5 days. The readmission rate was 6·0 per cent and 30-day mortality was zero.
  
  
  CONCLUSIONS
  Fast-track principles for perioperative care were introduced successfully and are safe after liver resection. Routine discharge 2 days after laparoscopic resection and 4-5 days after open liver resection may be feasible.
authors.affiliation: Departments of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: N A
authors.initials: NA
authors.lastname: Schultz
authors.forename: P N
authors.initials: PN
authors.lastname: Larsen
authors.forename: B
authors.initials: B
authors.lastname: Klarskov
authors.forename: L M
authors.initials: LM
authors.lastname: Plum
authors.forename: H J
authors.initials: HJ
authors.lastname: Frederiksen
authors.forename: B M
authors.initials: BM
authors.lastname: Christensen
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
authors.forename: J G
authors.initials: JG
authors.lastname: Hillingsø
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation* / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000534:rehabilitation; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D019990:Perioperative Care / Q000379:methods* / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011446:Prospective Studies; D055815:Young Adult