Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study

Bobby V M Dasari; Rasha Rahman; Shakeeb Khan; Davinia Bennett; James Hodson; John Isaac; Ravi Marudanayagam; Darius F Mirza; Paolo Muiesan; Keith J Roberts; Robert P Sutcliffe

doi:10.1111/hpb.12447

Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study

Bobby V M Dasari, Rasha Rahman, Shakeeb Khan, Davinia Bennett, James Hodson, John Isaac, Ravi Marudanayagam, Darius F Mirza, Paolo Muiesan, Keith J Roberts, Robert P Sutcliffe

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16 Citations (Scopus)

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.

CONCLUSION: 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.

Original language	English
Pages (from-to)	700-6
Number of pages	7
Journal	HPB : the official journal of the International Hepato Pancreato Biliary Association
Volume	17
Issue number	8
DOIs	https://doi.org/10.1111/hpb.12447
Publication status	Published - Aug 2015

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Dasari, B. V. M., Rahman, R., Khan, S., Bennett, D., Hodson, J., Isaac, J., Marudanayagam, R., Mirza, D. F., Muiesan, P., Roberts, K. J., & Sutcliffe, R. P. (2015). Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study. HPB : the official journal of the International Hepato Pancreato Biliary Association, 17(8), 700-6. https://doi.org/10.1111/hpb.12447

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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.CONCLUSION: 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.",

author = "Dasari, {Bobby V M} and Rasha Rahman and Shakeeb Khan and Davinia Bennett and James Hodson and John Isaac and Ravi Marudanayagam and Mirza, {Darius F} and Paolo Muiesan and Roberts, {Keith J} and Sutcliffe, {Robert P}",

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Dasari, BVM, Rahman, R, Khan, S, Bennett, D, Hodson, J, Isaac, J, Marudanayagam, R, Mirza, DF, Muiesan, P, Roberts, KJ & Sutcliffe, RP 2015, 'Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study', HPB : the official journal of the International Hepato Pancreato Biliary Association, vol. 17, no. 8, pp. 700-6. https://doi.org/10.1111/hpb.12447

TY - JOUR

T1 - Safety and feasibility of an enhanced recovery pathway after a liver resection

T2 - prospective cohort study

AU - Dasari, Bobby V M

AU - Rahman, Rasha

AU - Khan, Shakeeb

AU - Bennett, Davinia

AU - Hodson, James

AU - Isaac, John

AU - Marudanayagam, Ravi

AU - Mirza, Darius F

AU - Muiesan, Paolo

AU - Roberts, Keith J

AU - Sutcliffe, Robert P

PY - 2015/8

Y1 - 2015/8

N2 - 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.CONCLUSION: 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.

AB - 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.CONCLUSION: 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.

U2 - 10.1111/hpb.12447

DO - 10.1111/hpb.12447

M3 - Article

C2 - 26099347

SN - 1365-182X

VL - 17

SP - 700

EP - 706

JO - HPB : the official journal of the International Hepato Pancreato Biliary Association

JF - HPB : the official journal of the International Hepato Pancreato Biliary Association

IS - 8

ER -

Safety and feasibility of an enhanced recovery pathway after a liver resection: prospective cohort study

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