Enhanced recovery after liver surgery: safety and efficacy

Here is my highlight from the August edition of the journal HPB (impact factor 2.675)
Enhanced recovery after surgery (ERAS) programmes have taken the surgical world by storm. Liver surgery is no
exception and a number of studies have examined the role of ERAS in this branch of surgery.
In this edition of HPB, Dasari and colleagues from Birmingham, UK, looked at outcomes of patients undergoing
liver resection for a 6 month period before and after implementing a structured ERAS programme. What they found
was that there was a reduction in post-operative complications but not in post-operative length of stay. Many ERAS
intervention studies have reported a reduction in length of stay or time to functional recovery and in this study the
authors attributed the lack of difference to age and comorbidity, but it may be they had already adopted practices
associated with enhanced recovery as part of their standard management but before implementation of a formal ERAS
programme. The reduction in complications is interesting because this pertained to a number of different complica-
tions with no obvious common thread. This finding probably supports the notion that it is the complete package of
ERAS elements that contributes to improved outcome rather than one or two particular elements.
This study excluded certain groups of patients including those undergoing ALPPS, concomitant biliary or vascular resec-
tion and those undergoing living donation procedures. The first two groups are understandable but a strong case can be
made for early mobilization and enhanced recovery of patients undergoing living liver donation, particularly if as in this
study, it is associated with lower complication rates.
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