title: Enhanced recovery following liver surgery: a systematic review and meta-analysis.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) programmes aim to improve postoperative outcomes. They are being utilized increasingly in hepatic surgery. This review aims to evaluate the impact of ERAS programmes on outcomes following liver surgery.
  
  
  METHODS
  EMBASE, MEDLINE, PubMed and the Cochrane Database were searched for trials comparing outcomes in patients undergoing liver surgery utilizing ERAS principles with those in patients receiving conventional care. The primary outcome was occurrence of postoperative complications within 30 days. Secondary outcomes included length of stay (LoS), functional recovery and adherence to ERAS protocols.
  
  
  RESULTS
  Nine articles were included in the review, of which two were randomized controlled trials (RCTs). Overall complication rates were 25.0% (range: 11.5-46.4%) in ERAS patients, and 31.0% (range: 11.8-46.2%) in conventional care patients. Significantly reduced overall complication rates following ERAS care were demonstrated by a meta-analysis of the data reported in the two RCTs (odds ratio: 0.49, 95% confidence interval 0.28-0.84; P = 0.01) The median LoS reported by the studies was 5.0 days (range: 2.5-7.0 days) in ERAS patients, and 7.5 days (range: 3.0-11.0 days) in non-ERAS patients. Recovery milestones, when reported, were improved following ERAS care.
  
  
  CONCLUSIONS
  The adoption of ERAS protocols improves morbidity and LoS following liver surgery. Future ERAS programmes should accommodate the unique requirements of liver surgery in order to optimize postoperative outcomes.
authors.affiliation: Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hughes
authors.forename: Stephen
authors.initials: S
authors.lastname: McNally
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wigmore
mesh_terms: D016009:Chi-Square Distribution; D002985:Clinical Protocols; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery*; D016017:Odds Ratio; D011182:Postoperative Care / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome