title: Patient-Reported Outcomes Accurately Measure the Value of an Enhanced Recovery Program in Liver Surgery.
abstract: BACKGROUND
  Enhanced recovery (ER) pathways have become increasingly integrated into surgical practice. Studies that compare ER and traditional pathways often focus on outcomes confined to inpatient hospitalization and rarely assess a patient's functional recovery. The aim of this study was to compare functional outcomes for patients treated on an Enhanced Recovery in Liver Surgery (ERLS) pathway vs a traditional pathway.
  
  
  METHODS
  One hundred and eighteen hepatectomy patients rated symptom severity and life interference using the validated MD Anderson Symptom Inventory preoperatively and postoperatively at every outpatient visit until 31 days after surgery. The ERLS protocol included patient education, narcotic-sparing anesthesia and analgesia, diet advancement, restrictive fluid administration, early ambulation, and avoidance of drains and tubes.
  
  
  RESULTS
  Seventy-five ERLS pathway patients were clinically comparable with 43 patients simultaneously treated on a traditional pathway. The ERLS patients reported lower immediate postoperative pain scores and experienced fewer complications and decreased length of stay. As measured by symptom burden on life interference, ERLS patients were more likely to return to baseline functional status in a shorter time interval. The only independent predictor of faster return to baseline interference levels was treatment on an ERLS pathway (p = 0.021; odds ratio = 2.62). In addition, ERLS pathway patients were more likely to return to intended oncologic therapy (95% vs 87%) at a shorter time interval compared to patients on the traditional pathway (44.7 vs 60.2 days).
  
  
  CONCLUSIONS
  In oncologic liver surgery, enhanced recovery's primary mechanism of action is reduction in life interference by postoperative surgical symptoms, allowing patients to return sooner to normal function and adjuvant cancer therapies.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Day
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Xin S
authors.initials: XS
authors.lastname: Wang
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Sharon
authors.initials: S
authors.lastname: Fielder
authors.affiliation: Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: John
authors.initials: J
authors.lastname: Calhoun
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Claudius
authors.initials: C
authors.lastname: Conrad
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.affiliation: Department of Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Gottumukkala
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: taaloia@mdanderson.org.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D004434:Early Ambulation; D005260:Female; D006498:Hepatectomy / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011182:Postoperative Care; D020127:Recovery of Function; D057566:Self Report