Enhanced recovery after liver surgery: a new challenge awaits

Here are my highlights from the April issue of the journal HPB.

I think it is safe to say that enhanced recovery after surgery (ERAS) is here to stay. The majority of studies that have looked at ERAS protocols of anaesthetic, analgesic and perioperative care refinement have shown benefit. This benefit also transcends different types of surgery and early successes in colorectal surgery are being replicated in orthopaedics and other branches of surgery.

Liver surgery is included in this, and both Coolsen et al. from Maastricht and Connor et al. from Christchurch, provide evidence of benefit from ERAS programmes. Coolsen et al. undertook a systematic review which showed reduced length of stay without increased morbidity or mortality from the use of ERAS programmes.

Connor et al., in a single-centre study, also showed reduced length of postoperative stay among patients treated using ERAS principles although they noted an increased rate of readmissions in patients as a cost of early discharge.

One aspect not dealt with by either study is what I term ‘ERAS fatigue’. We have noticed in our institution that when we have an ERAS study running admissions are very short but when the study ends length of stay increases. Behaviours established during the study slip and old habits are adopted. I am sure that we are not unique. Having established the undoubted benefits of ERAS protocols it is now a challenge to find ways of embedding these in clinical practice to ensure that excellent results found in ERAS studies become the routine in day to day HPB surgery.

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Photo by Sha Sha Chu Flickr Creative Commons

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