title: Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection.
abstract: BACKGROUND
  Enhanced recovery pathways (ERP) have not been widely implemented for hepatic surgery. The aim of this study was to evaluate the safety of an ERP for patients undergoing open hepatic resection.
  
  
  METHODS
  A single-surgeon, retrospective observational cohort study was performed comparing the clinical outcomes of patients undergoing open hepatic resection treated before and after implementation of an ERP. Morbidity, mortality, and length of hospital stay (LOS) were compared between pre-ERP and ERP groups.
  
  
  RESULTS
  126 patients (pre-ERP n = 73, ERP n = 53) were identified for the study. Patient characteristics and operative details were similar between groups. Overall complication rate was similar between pre-ERP and ERP groups (37% vs. 28%, p = 0.343). Before and after pathway implementation, the median LOS was similar, 5 (IQR 4-7) vs. 5 (IQR 4-6) days, p = 0.708. After adjusting for age, type of liver resection, and ASA, the ERP group had no increased risk of major complication (OR 0.38, 95% CI 0.14-1.02, p = 0.055) or LOS greater than 5 days (OR 1.21, 95% CI 0.56-2.62, p = 0.627).
  
  
  CONCLUSIONS
  Routine use of a multimodal ERP is safe and is not associated with increased postoperative morbidity after open hepatic resection.
authors.affiliation: Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.
authors.forename: Clancy J
authors.initials: CJ
authors.lastname: Clark
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Shahzad M
authors.initials: SM
authors.lastname: Ali
authors.affiliation: Department of General Surgery, University of Virginia, Charlottesville, Virginia, United States of America.
authors.forename: Victor
authors.initials: V
authors.lastname: Zaydfudim
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Jacob
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods*; D012189:Retrospective Studies; D012449:Safety