Enhanced recovery protocol after liver resection.
BACKGROUND
Enhanced recovery protocols (ERPs) accelerate patient recovery and shorten hospital stay by optimization of perioperative care. However, experience with ERPs is still limited in liver surgery.


METHODS
The implementation of a multimodal ERP was studied in patients who underwent open and laparoscopic liver surgery. An opioid-sparing pain treatment was chosen together with early mobilization and oral feeding, as well as restricted use of abdominal drains and catheters. Date to discharge, postoperative complications and patient satisfaction were assessed. A historical cohort of patients who underwent liver resection served as a control group.


RESULTS
Some 134 liver resections (126 open, 8 laparoscopic) were performed between April 2013 and March 2014. Operations were carried out mostly for malignant liver tumours. One hundred and six (79.1 per cent) of the 134 patients were discharged by the fifth postoperative day. The median (range) postoperative hospital stay was 4 (2-11) days, compared with 6 (4-16) days for the control group (P < 0.001). Only four patients in the ERP group were readmitted and the 30-day mortality rate was zero.


CONCLUSIONS
An ERP for perioperative care after liver surgery was introduced safely and effectively. Discharge within 4 days is achievable with no increase in adverse events and good patient satisfaction.
Departments of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland.
J
J
Savikko
Departments of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
M
M
Ilmakunnas
Departments of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland.
H
H
Mäkisalo
Departments of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland.
A
A
Nordin
Departments of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland.
H
H
Isoniemi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008113:Liver Neoplasms / Q000601:surgery*; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019990:Perioperative Care / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D055815:Young Adult