title: Is current perioperative practice in hepatic surgery based on enhanced recovery after surgery (ERAS) principles?
abstract: BACKGROUND
  The worldwide introduction of multimodal enhanced recovery programs has also changed perioperative care in patients who undergo liver resection. This study was performed to assess current perioperative practice in liver surgery in 11 European HPB centers and compare it to enhanced recovery after surgery (ERAS) principles.
  
  
  METHODS
  In each unit, 15 consecutive patients (N = 165) who underwent hepatectomy between 2010 and 2012 were retrospectively analyzed. Compliance was classified as "full," "partial," or "poor" whenever ≥ 80, ≥ 50, or <50 % of the 22 ERAS protocol core items were met. The primary study end point was overall compliance with the ERAS core program per unit and per perioperative phase.
  
  
  RESULTS
  Most patients were operated on for malignancy (91 %) and 56 % were minor hepatectomies. The median number of implemented ERAS core items was 9 (range = 7-12) across all centers. Compliance was partial in the preoperative (median 2 of 3 items, range = 1-3) and perioperative phases (median 5 of 10 items, range: 4-7). Median postoperative compliance was poor (median 2 of 9 items, range = 0-4). A statistically significant difference was observed between median length of stay and median time to recovery (7 vs. 5 days, P < 0.001).
  
  
  CONCLUSIONS
  Perioperative care among centers that perform liver resections varied substantially. In current HPB surgical practice, some elements of the ERAS program, e.g., preoperative counselling and minimal fasting, have already been implemented. Elements in the perioperative phase (avoidance of drains and nasogastric tube) and postoperative phase (early resumption of oral intake, early mobilization, and use of recovery criteria) should be further optimized.
authors: Department of Surgery, Maastricht University Medical Center, PO Box 616, 6200 MD, Maastricht, The Netherlands, e.wong@maastrichtuniversity.nl.
authors: E M
authors: EM
authors: Wong-Lun-Hing
authors: R M
authors: RM
authors: van Dam
authors: L A
authors: LA
authors: Heijnen
authors: O R C
authors: OR
authors: Busch
authors: T
authors: T
authors: Terkivatan
authors: R
authors: R
authors: van Hillegersberg
authors: G D
authors: GD
authors: Slooter
authors: J
authors: J
authors: Klaase
authors: J H W
authors: JH
authors: de Wilt
authors: K
authors: K
authors: Bosscha
authors: U P
authors: UP
authors: Neumann
authors: B
authors: B
authors: Topal
authors: L A
authors: LA
authors: Aldrighetti
authors: C H C
authors: CH
authors: Dejong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000592:standards*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult