title: Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study.
abstract: BACKGROUND
  In contrast to colorectal surgery, enhanced recovery pathways (ERPs) have not yet become standard practice after major upper abdominal surgery. The aim of this study was to assess the feasibility and outcomes after implementation of an ERP after liver a resection.
  
  
  METHODS
  Patients who underwent a liver resection in two consecutive 6-month periods before (July-December 2013) and after (January-June 2014) implementation of an ERP were included in a prospective study. Patients who underwent live donation, ALPPS (associating liver partition with portal vein ligation for staged hepatectomy) or concomitant procedures were excluded. Peri-operative outcomes were compared between groups, and multivariate analysis of factors influencing the length of hospital stay (LOS) was performed.
  
  
  RESULTS
  Two hundred and eleven patients (93 pre-ERP and 91 post-ERP patients) underwent a liver resection during the study period. There was no significant difference in the median LOS (P = 0.907) and 30-day readmission rates (P = 0.645) between the groups. Severe (Clavien grade III-V) complications were reduced in ERP patients (13.9% versus 4.3%; P = 0.039). On multivariate analysis, an increased age (< 0.001), open resection (< 0.001) and complications (< 0.001) were associated with an increased LOS.
  
  
  CONCLUSIONS
  Enhanced recovery after a liver resection appears to be safe, feasible and may reduce severe complications. However, the LOS was significantly influenced by patient age, open surgery and post-operative complications, but not by an ERP.
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Bobby V M
authors.initials: BV
authors.lastname: Dasari
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Rasha
authors.initials: R
authors.lastname: Rahman
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Shakeeb
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Anaesthesia, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Davinia
authors.initials: D
authors.lastname: Bennett
authors.affiliation: Wolfson Laboratory, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: James
authors.initials: J
authors.lastname: Hodson
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Ravi
authors.initials: R
authors.lastname: Marudanayagam
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Roberts
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sutcliffe
mesh_terms: D000368:Aged; D015992:Body Mass Index; D019091:Critical Pathways; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010359:Patient Readmission; D061214:Patient Safety; D019990:Perioperative Care; D011182:Postoperative Care; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome