Key result
Implementation of 2016 ERAS recommendations for hepatectomy significantly reduced overall morbidity compared to pre-implementation care (42.5% vs. 64.7%, p<0.001).
Why the study?
The ERAS society published new recommendations for hepatectomy in 2016, but few studies had evaluated their clinical impact, particularly in cirrhotic patients.
Does the implementation of 2016 ERAS guidelines improve 90-day morbidity in patients undergoing hepatectomy?
Cohort (n=430)
No
Does the implementation of 2016 ERAS guidelines improve 90-day morbidity in patients undergoing hepatectomy?
Implementation of 2016 ERAS guidelines for hepatectomy significantly reduces non-severe morbidity and length of stay in non-cirrhotic patients, but shows no significant benefit in cirrhotic patients.
May support ERAS in non-cirrhotic hepatectomy; leaves open benefits in cirrhosis and requires randomized confirmation.
BACKGROUND: The Enhanced Recovery After Surgery (ERAS) society published new recommendations for hepatectomy in 2016. Few studies have assessed their clinical impact. The aim of this monocentric study was to assess the impact of those guidelines on outcomes after liver surgery with a special focus on cirrhotic patients. METHOD: Postoperative outcomes of patients undergoing hepatectomy 30 months before and after ERAS implementation according to the 2016 ERAS guidelines were compared after inverse probability of treatment weighting (IPTW). Primary endpoint was 90-day morbidity. RESULTS: From 2015 to 2020, 430 patients underwent hepatectomy including 226 procedures performed before and 204 after ERAS implementation. After IPTW, overall morbidity (42.5% vs. 64.7%, p < 0.001), Comprehensive Complication Index (CCI) score (14.3 vs. 20.8, p = 0.004), length of stay (10.4 vs. 13.7 days, p = 0.001) and textbook outcome (50% vs. 40.2%, p = 0.022) were significantly improved in the ERAS group, while mortality and severe complications were similar in both groups. In the non-cirrhosis subgroup (n = 321), these results were confirmed. However, in the cirrhosis subgroup (n = 105), no difference appeared on outcomes after hepatectomy with an overall morbidity (47.5% vs. 65.2%, p = 0.069) and a length of stay (8 vs. 9 days, p = 0.310) which were not significantly different. The compliance rate to ERAS guidelines was 60% in both cirrhotic and non-cirrhotic subgroups. CONCLUSION: Perioperative ERAS program for hepatectomy results in improved outcomes with decreased rate of non-severe morbidity. Although those guidelines are not deleterious for cirrhotic patients, they probably require revisions to be more effective in this patient population.
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Lunel et al. (2021) conducted a cohort in Hepatectomy (n=430). 2016 Enhanced Recovery After Surgery (ERAS) recommendations vs. Before ERAS implementation was evaluated on 90-day morbidity (p=< 0.001). Implementation of 2016 ERAS recommendations for hepatectomy significantly reduced overall morbidity compared to pre-implementation care (42.5% vs. 64.7%, p<0.001).
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