Enhanced Recovery After Surgery (ERAS) Protocols is Extremely Beneficial in Liver Surgeries - A Meta-Analysis

Bhavin Vasavada^1, and Hardik Patel¹

¹Consultant Hepatobiliary and Liver Transplant Surgeon, Shalby Hospitals, Ahmedabad, India

Cite this paper:
Bhavin Vasavada and Hardik Patel. Enhanced Recovery After Surgery (ERAS) Protocols is Extremely Beneficial in Liver Surgeries - A Meta-Analysis. International Journal of Celiac Disease. 2020; 8(4):147-152. doi: 10.12691/ijcd-8-4-8

Abstract

BACKGROUND: Enhanced recovery after surgery (ERAS) programs aim to improve postoperative outcomes. This meta-analysis aims to evaluate the impact of ERAS programmes on outcomes following liver surgeries. METHODS: EMBASE, MEDLINE, PubMed and the Cochrane Database were searched for studies comparing outcomes in patients undergoing liver surgery utilizing ERAS principles with those patients receiving conventional care. The primary outcome was the occurrence of 30-day morbidity and mortality. Secondary outcomes included length of stay, functional recovery, readmission rates, time to pass flatus, blood loss and hospital costs. RESULTS: Ten articles were included in the meta-analysis. 30 days morbidity and mortality were significantly less in the ERAS group. Hospital stay, time to pass flatus, time to complete recovery and hospital costs were also significantly reduced due to ERAS protocols. Blood loss and readmission rates were also significantly less in the ERAS group. CONCLUSIONS: The adoption of ERAS protocols significantly reduced morbidity, mortality hospital stay, readmission rates, time to recovery, hospital costs, time to pass flatus, blood loss and readmission rates.

Keywords:
enhanced recovery after surgery liver surgery HPB surgery morbidity mortality liver resection fast track surgery

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Figures

References:

[1]	Pędziwiatr M, Mavrikis J, Witowski J, et al. Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol. 2018 May 9; 95.
[2]	Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1; 292-298.
[3]	Melnyk M, Casey RG, Black P, et al. Enhanced recovery after surgery (ERAS) protocols: Time to change practice? Can UrolAssoc J. 2011 Oct; 342-8.
[4]	Ljungqvist O. ERAS--enhanced recovery after surgery: moving evidence-based perioperative care to practice. JPEN. Jul; 38(5): 559-66.
[5]	Bobby V. M. Dasari, RashaRahman, Shakeeb Khan et al. Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study. HPB 2015, 700-706.
[6]	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000 Apr 19; 2008-12.
[7]	Liberati A, Altman DG, Tetzlaff J et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J ClinEpidemiol. 2009 Oct; e1-34.
[8]	Higgins JP, Thompson SG (2002). Quantifying heterogeneity in a meta-analysis. Stat Med.1539-1558.
[9]	HozoSP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5: 13.
[10]	Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. September 1, 2016.
[11]	Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928.
[12]	Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery. Arch Surg: 961-969.
[13]	He F, Lin X, Xie F, et al. The effect of enhanced recovery pro-gram for patients undergoing partial laparoscopic hepatectomy of liver cancer. ClinTranslOncol. 2015.
[14]	Jones C, Kelliher L, Dickinson M, et al Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg:1015-1024.
[15]	Lu H, Fan Y, Zhang F, et al. Fast-track surgery improves postoperative outcomes after hepatectomy. Hepatogastroenterology 61: 168-172.
[16]	Ni CY, Yang Y, Chang YQ, et al. Fast-track surgery improves postoperative recovery in patients undergo-ing partial hepatectomy for primary liver cancer: a prospective rand-omized controlled trial. Eur J SurgOncol 39:542-547.
[17]	sánchez-Pérez B, Aranda-NarváezJM, Suárez-Muñoz MA, et al. Fast-track program in laparoscopic liver surgery: theory or fact? World J Gastrointest Surg 2012; 4; 246-250.
[18]	R. M. van Dam, P. O. Hendry, M. M. E. Coolsen, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. British Journal of Surgery 2008; 95: 969-975.
[19]	Bobby V. M. Dasari, RashaRahman, et al. Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study. HPB 2015, 17, 700-706.
[20]	Jonathan B. Koea, Yatin Young, et al. Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia. HPB Surgery 2009.
[21]	Xiao Liang, Hanning Ying, MM, Hongwei Wang et al. Hongxia Xu, BN, Hong Yu, MD, Liuxin Cai, MD et al. Enhanced Recovery Program Versus Traditional Care in Laparoscopic Hepatectomy. Medicine; 2016; 95.
[22]	De-Xin Lin, Xuan Li ,Qi-Wen Yet al.Implementation of a Fast-Track Clinical Pathway Decreases Postoperative Length of Stay and Hospital Charges for Liver Resection. Cell BiochemBiophys 2011; 61; 413-419.