Key result
The absence of an Enhanced Recovery after Surgery (ERAS) protocol was associated with a twofold increased risk of postoperative complications (OR 2.0) following liver resection, regardless of surgical complexity or patient age.
Why the study?
To assess the performance of a 3-level complexity classification for liver resection procedures and evaluate whether the Enhanced Recovery after Surgery protocol improves postoperative outcomes across complexity grades.
Does the ERAS protocol reduce postoperative complications in patients undergoing liver resection across different surgical complexity grades?
Cohort (n=437)
No
Does the ERAS protocol reduce postoperative complications in patients undergoing liver resection across different surgical complexity grades?
The ERAS protocol significantly decreases the probability of postoperative complications across all surgical complexity grades of liver resection.
Answers are grounded in this paper and cite their sources.
May support ERAS consideration to reduce liver resection complications; leaves open randomized confirmation across complexity grades.
BACKGROUND: The current study aimed to assess the performance of the 3-level complexity classification that stratified liver resection procedures into 3 complexity grades (grade I, low; grade II, intermediate; and grade III, high complexity) and to evaluate whether the Enhanced Recovery after Surgery (ERAS) protocol improves postoperative outcomes for each complexity grade. STUDY DESIGN: Consecutive patients undergoing open liver resection and laparoscopic liver resection at Lausanne University Hospital during 2010 to 2020 were assessed. RESULTS: A total of 437 patients were included. Operative time, estimated blood loss, and length of hospital stay increased significantly, with a stepwise increase of the grades from I to III in open liver resection and laparoscopic liver resection (all, p < 0.05). The same trend for Comprehensive Complication Index was found in open liver resection (p < 0.005). Age (p = 0.004), 3-level complexity classification (grade II vs I; p = 0.001; grade III vs I; p < 0.001), no use of the ERAS protocol (p = 0.016), and biliary reconstruction (p < 0.001) were significant predictors for postoperative complication, defined as Comprehensive Complication Index ≥ 26.2 in a multivariable logistic regression analysis. The prediction model incorporating the 4 factors had a calculated Concordance Index of 0.735 and 0.742 based on the bootstrapping method. The use of ERAS protocol was associated with lower probability of postoperative complication for each complexity grade and age. CONCLUSIONS: The use of ERAS protocol can decrease the probability of postoperative complication for each surgical complexity of liver resection and patient age. This finding emphasized the importance of tailoring perioperative management according to surgical complexity and patient age to improve outcomes after liver resection.
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Kobayashi et al. (2021) conducted a cohort in Liver tumors requiring resection (n=437). No ERAS protocol vs. ERAS protocol was evaluated on Postoperative complication (Comprehensive Complication Index ≥ 26.2) (OR 2.0, 95% CI 1.1-3.5, p=0.016). The absence of an Enhanced Recovery after Surgery (ERAS) protocol was associated with a twofold increased risk of postoperative complications (OR 2.0) following liver resection, regardless of surgical complexity or patient age.
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