Study evaluates effectiveness of ERAS protocols in liver resection surgery

Liver resection is a challenging surgical procedure with inherent risks for both the anesthesiologist and the surgeon. Prof. Henrik Kehlet's concept of Enhanced Recovery After Surgery (ERAS) focuses on evidence-based strategies to minimize the physiological stress of surgery, resulting in quicker recovery, shorter hospital stays, and better postoperative results. Recent retrospective cohort study focuses on the compliance to Enhanced Recovery After Surgery (ERAS) in liver resection and its correlation with patient outcomes. The study evaluates the compliance with 21 out of 25 ERAS recommendations for liver surgery and its association with the length of hospital stay (LOS) and the development of complications. The study included 44 hepatectomy patients and showed an overall compliance of 77%. Individual component compliance varied, with lower compliance rates in aspects such as fasting, carbohydrate loading, minimally invasive surgical techniques, and avoidance or early removal of the drain. The study divided the cohort into two groups based on their compliance with ERAS components. Group 1 had compliance to ≥75% of the elements, while group 2 had compliance to <75%. The results indicated that higher ERAS compliance was associated with reduced complications, although LOS differences were not statistically significant. Severe complications such as re‑exploration and death were noted in patients with compliance to fewer than 75% of the components. The paper stresses the potential clinical and financial benefits of increased ERAS compliance for patients undergoing liver resection surgery.

ERAS Principles and Global Application

The paper highlights the stress response associated with major abdominal surgery and the relevance of implementing evidence-based ERAS practices to reduce surgical stress, promote faster recovery times, and improve surgical outcomes. It emphasizes the global adoption of ERAS principles and the application of the concept to surgical specialties beyond colorectal surgeries. The study also discusses the variability in individual compliance rates with various ERAS components, with some components showing good compliance rates and others showing lower compliance rates.

The paper acknowledges the limitations of its retrospective design and relatively small sample size. It suggests the need for larger, preferably prospective, and randomized studies to further investigate the observations. Despite the limitations, the study demonstrates the potential for implementing ERAS protocols in liver surgery through institutional protocols and a multidisciplinary approach. It underscores the overall effectiveness of the ERAS protocol and encourages healthcare practitioners to closely follow it to benefit patients undergoing liver resection surgery.

Key Points

1. The research paper is a retrospective cohort study that evaluates the compliance to Enhanced Recovery After Surgery (ERAS) in liver resection and its correlation with patient outcomes. It includes 44 hepatectomy patients and shows an overall compliance of 77% with 21 out of 25 ERAS recommendations for liver surgery.

2. The study divides the cohort into two groups based on their compliance with ERAS components, with Group 1 having compliance to ≥75% of the elements, and Group 2 having compliance to <75%. Higher ERAS compliance is associated with reduced complications, although length of hospital stay (LOS) differences were not statistically significant. Patients with compliance to fewer than 75% of the components experienced severe complications such as re‑exploration and death.

3. The paper emphasizes the global adoption of ERAS principles and their relevance in reducing surgical stress, promoting faster recovery, and improving surgical outcomes. It highlights the variability in individual compliance rates with various ERAS components, with some components showing good compliance rates and others showing lower compliance rates.

4. It stresses the potential clinical and financial benefits of increased ERAS compliance for patients undergoing liver resection surgery, advocating for the implementation of evidence-based ERAS practices to improve patient outcomes. The study underscores the overall effectiveness of the ERAS protocol and encourages healthcare practitioners to closely follow it.

5. The paper acknowledges the limitations of its retrospective design and relatively small sample size, suggesting the need for larger, preferably prospective, and randomized studies to further investigate the observations. It emphasizes the potential for implementing ERAS protocols in liver surgery through institutional protocols and a multidisciplinary approach.

6. The study promotes the importance of complying with ERAS recommendations for liver surgery, particularly in aspects such as fasting, carbohydrate loading, minimally invasive surgical techniques, and avoidance or early removal of the drain, to benefit patients undergoing liver resection surgery.

Reference –

Pradhan A, Sarkar A, Haldar S, Chakraborty A, Pal AR. Compliance to enhanced recovery program in liver resection surgery: A retrospective cohort study. J Anaesthesiol Clin Pharmacol 2024.