Enhanced recovery in the resection of colorectal liver metastases.
BACKGROUND
There is limited evidence for the use of enhanced recovery after surgery (ERAS) in patients undergoing hepatectomy, and the impact of the evolution of ERAS over time has not been examined. This study sought to evaluate the effect of an evolving ERAS program in patients undergoing hepatectomy for colorectal liver metastases (CRLM).


METHODS
A multimodal ERAS program was introduced in 2/2008. Consecutive patients undergoing hepatectomy for CRLM between 2/2008 and 9/2012 were included in the study. Data were collected prospectively. Retrospective analysis compared an early ERAS cohort (2/2008-4/2010) with a later cohort with a matured ERAS program (5/2010-8/2012).


RESULTS
Length of stay reduced as experience of ERAS increased (Log-rank χ(2)  = 10.43, P = 0.001). Although median length of stay remained unchanged (6 days), the probability of hospitalization beyond 10 days was 25% in the early cohort compared with 7% in the later cohort. Critical care utilization reduced over time (75.5% vs. 54.7%, P < 0.0001). Complications occurred in 38.2%, with no difference in between cohorts. One postoperative death occurred in the early cohort (<0.3%).


CONCLUSIONS
This study suggests that as experience of ERAS evolves, there is a progressive reduction in hospitalization and critical care admission. This is without any increase in morbidity and mortality.
Liverpool Hepatobiliary Centre, University Hospital Aintree, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
Declan F J
DF
Dunne
Vincent S
VS
Yip
Robert P
RP
Jones
Ewan A
EA
McChesney
Daniel T
DT
Lythgoe
Eftychia E
EE
Psarelli
Louise
L
Jones
Carmen
C
Lacasia-Purroy
Hassan Z
HZ
Malik
Graeme J
GJ
Poston
Stephen W
SW
Fenwick
D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000592:standards; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
ERAS; colorectal liver metastasis; enhanced recovery; fast track; hepatectomy