Introduction
Methods
Participants
Study variables
Study outcome
Statistical analysis
Results
Baseline characteristics
All (N = 318) | ERSA (N = 150) | Non-ERSA (N = 168) | P | |
---|---|---|---|---|
Age at diagnosis (year)
| 55.0 (10.5) | 54.2 (10.8) | 55.7 (10.1) | 0.210 |
Sex
| 0.885 | |||
Female | 72 (22.6%) | 35 (23.3%) | 37 (22.0%) | |
Male | 246 (77.4%) | 115 (76.7%) | 131 (78.0%) | |
BMI
| 23.1 [20.9;24.9] | 22.7 [20.6;24.6] | 23.4 [21.3;25.3] | 0.149 |
Education level
| 0.823 | |||
No school/primary education | 79 (24.8%) | 37 (24.7%) | 42 (25.0%) | |
Middle Education | 106 (33.3%) | 53 (35.3%) | 53 (31.5%) | |
High education | 68 (21.4%) | 29 (19.3%) | 39 (23.2%) | |
University education | 65 (20.4%) | 31 (20.7%) | 34 (20.2%) | |
Comorbidity
| 0.230 | |||
No | 273 (85.8%) | 133 (88.7%) | 140 (83.3%) | |
Yes | 45 (14.2%) | 17 (11.3%) | 28 (16.7%) | |
Chronic smoking
| 0.748 | |||
No | 239 (75.2%) | 111 (74.0%) | 128 (76.2%) | |
Yes | 79 (24.8%) | 39 (26.0%) | 40 (23.8%) | |
Chronic drinking
| 0.065 | |||
No | 273 (85.8%) | 135 (90.0%) | 138 (82.1%) | |
Yes | 45 (14.2%) | 15 (10.0%) | 30 (17.9%) | |
ALT (U/L)
| 26.0 [19.0;33.0] | 25.0 [19.0;33.0] | 27.0 [20.0;34.0] | 0.264 |
AST (U/L)
| 24.0 [17.0;30.8] | 23.0 [17.0;30.0] | 25.0 [18.0;31.0] | 0.375 |
PLT (×109 L)
| 194 [139;240] | 193 [144;233] | 196 [136;247] | 0.546 |
HB (g/L)
| 138 [125;151] | 138 [127;150] | 138 [123;151] | 0.587 |
WB (×109 L)
| 5.38 [4.38;6.64] | 5.20 [4.26;6.51] | 5.54 [4.67;6.83] | 0.087 |
Creatinine (umol/L)
| 73.5 [63.0;82.8] | 73.0 [62.0;81.0] | 74.0 [64.0;84.0] | 0.362 |
ALB (g/L)
| 41.2 [38.7;43.6] | 41.5 [38.5;44.2] | 41.0 [39.1;43.2] | 0.310 |
TBIL (umol/L)
| 11.8 [8.53;15.9] | 11.6 [8.60;14.8] | 11.9 [8.50;17.2] | 0.136 |
ASA: | 0.185 | |||
I + II | 225 (70.8%) | 112 (74.7%) | 113 (67.3%) | |
III | 93 (29.2%) | 38 (25.3%) | 55 (32.7%) | |
Surgical approach
| 0.679 | |||
Laparoscopic technique | 95 (29.9%) | 47 (31.3%) | 48 (28.6%) | |
Open | 223 (70.1%) | 103 (68.7%) | 120 (71.4%) | |
Extent of operation
| 0.835 | |||
Single segmentectomy | 139 (43.7%) | 67 (44.7%) | 72 (42.9%) | |
Two combined segmentectomies | 122 (38.4%) | 55 (36.7%) | 67 (39.9%) | |
Major hepatectomy | 57 (17.9%) | 28 (18.7%) | 29 (17.3%) | |
Surgical time (minute)
| 270 [217;333] | 274 [226;334] | 270 [212;329] | 0.287 |
Blood volume intraoperative (ml)
| 300 [100;500] | 225 [100;5.00] | 300 [100;500] | 0.081 |
Outcome comparison between ERAS and non-ERAS group
All | ERSA | Non-ERSA | P | |
---|---|---|---|---|
POD1 pain score
| 1.00 [1.00;2.00] | 1.00 [1.00;2.00] | 2.00 [1.00;2.00] | 0.167 |
POD2 pain score
| 4.00 [3.00;5.00] | 3.00 [2.00;4.00] | 5.00 [4.00;6.00] | < 0.001 |
POD3 pain score
| 3.00 [2.00;4.00] | 2.00 [1.00;3.00] | 4.00 [3.00;5.00] | < 0.001 |
Gastrointestinal function recovery days
| 2.00 [2.00;3.00] | 2.00 [1.00;2.00] | 3.00 [2.00;4.00] | < 0.001 |
Postoperative hospitalization days
| 6.00 [5.00;7.00] | 6.00 [5.00;7.00] | 6.00 [5.00;8.00] | < 0.001 |
Postoperative hospitalization days
| < 0.001 | |||
Six days or less | 199 (62.6%) | 110 (73.3%) | 89 (53.0%) | |
More than 6 days | 119 (37.4%) | 40 (26.7%) | 79 (47.0%) | |
Total cost (RMB)
| 82,638 [70,878;98,873] | 81,601 [70,960;96,134] | 83,459 [70,771;100,167] | 0.516 |
Rehospitalization after discharge (< 30 days)
| 0.079 | |||
No | 301 (94.7%) | 146 (97.3%) | 155 (92.3%) | |
Yes | 17 (5.35%) | 4 (2.67%) | 13 (7.74%) | |
Any postoperative complication
| 0.001 | |||
No | 221 (69.5%) | 118 (78.7%) | 103 (61.3%) | |
Yes | 97 (30.5%) | 32 (21.3%) | 65 (38.7%) | |
Wound infection
| 0.321 | |||
No | 279 (87.7%) | 135 (90.0%) | 144 (85.7%) | |
Yes | 39 (12.3%) | 15 (10.0%) | 24 (14.3%) | |
Deep vein thrombosis
| 1.000 | |||
No | 309 (97.2%) | 146 (97.3%) | 163 (97.0%) | |
Yes | 9 (2.83%) | 4 (2.67%) | 5 (2.98%) | |
Pleural effusion
| 0.036 | |||
No | 276 (86.8%) | 137 (91.3%) | 139 (82.7%) | |
Yes | 42 (13.2%) | 13 (8.67%) | 29 (17.3%) | |
Seroperitoneum
| 0.166 | |||
No | 281 (88.4%) | 137 (91.3%) | 144 (85.7%) | |
Yes | 37 (11.6%) | 13 (8.67%) | 24 (14.3%) | |
Biliary leakage: | 1.000 | |||
No | 313 (98.4%) | 148 (98.7%) | 165 (98.2%) | |
Yes | 5 (1.57%) | 2 (1.33%) | 3 (1.79%) | |
Postoperative bleeding again
| 0.453 | |||
No | 311 (97.8%) | 148 (98.7%) | 163 (97.0%) | |
Yes | 7 (2.20%) | 2 (1.33%) | 5 (2.98%) | |
Nausea/ vomiting
| 0.009 | |||
No | 229 (72.0%) | 119 (79.3%) | 110 (65.5%) | |
Yes | 89 (28.0%) | 31 (20.7%) | 58 (34.5%) | |
Ventosity
| 0.017 | |||
No | 245 (77.0%) | 125 (83.3%) | 120 (71.4%) | |
Yes | 73 (23.0%) | 25 (16.7%) | 48 (28.6%) |
Risk factors for the incidence of postoperative prolonged hospital stay
Postoperative hospitalization days of > 6 days | Risk factors of postoperative hospitalization days > 6 days | |||||
---|---|---|---|---|---|---|
univariable | multivariable-1 | multivariable-2 | ||||
Variables | No (N = 199) | Yes (N = 119) | P | OR (95%CI) | OR (95%CI) | OR (95%CI) |
Group
| < 0.001 | |||||
ERAS | 110 (55.3%) | 40 (33.6%) | 1 reference | 1 reference | 1 reference | |
Non-ERAS | 89 (44.7%) | 79 (66.4%) | 2.44 (1.52–3.91, p < .001) | 2.63 (1.57–4.43, p < .001) | 2.64 (1.59–4.38, p < .001) | |
Age at diagnosis
| 54.8 (11.1) | 55.2 (9.46) | 0.726 | 1.00 (0.98–1.03, p = .735) | ||
Sex
| 0.689 | |||||
Female | 47 (23.6%) | 25 (21.0%) | 1 reference | |||
Male | 152 (76.4%) | 94 (79.0%) | 1.16 (0.67–2.01, p = .591) | |||
BMI
| 23.2 [20.9;24.8] | 23.0 [20.9;25.5] | 0.947 | 1.00 (0.93–1.08, p = .920) | ||
Education level
| 0.903 | |||||
No school/primary education | 47 (23.6%) | 32 (26.9%) | 1 reference | |||
Middle Education | 66 (33.2%) | 40 (33.6%) | 0.89 (0.49–1.62, p = .702) | |||
High education | 44 (22.1%) | 24 (20.2%) | 0.80 (0.41–1.57, p = .517) | |||
University education | 42 (21.1%) | 23 (19.3%) | 0.80 (0.41–1.59, p = .529) | |||
Comorbidity
| 0.91 | |||||
No | 170 (85.4%) | 103 (86.6%) | 1 reference | |||
Yes | 29 (14.6%) | 16 (13.4%) | 0.91 (0.47–1.76, p = .780) | |||
Chronic smoking
| 1 | |||||
No | 150 (75.4%) | 89 (74.8%) | 1 reference | |||
Yes | 49 (24.6%) | 30 (25.2%) | 1.03 (0.61–1.74, p = .907) | |||
Chronic drinking
| 0.376 | |||||
No | 174 (87.4%) | 99 (83.2%) | ||||
Yes | 25 (12.6%) | 20 (16.8%) | 1.41 (0.74–2.66, p = .295) | |||
ALT (U/L)
| 27.0 [20.0;33.0] | 25.0 [18.0;33.5] | 0.273 | 0.98 (0.96–1.01, p = .293) | ||
AST (U/L)
| 25.0 [17.0;31.0] | 23.0 [18.0;29.0] | 0.547 | 0.99 (0.96–1.02, p = .598) | ||
PLT (×109 L)
| 195 [138;240] | 194 [140;242] | 0.777 | 1.00 (1.00–1.00, p = .773) | ||
HB (g/L)
| 137 [125;151] | 140 [124;150] | 0.828 | 1.00 (0.99–1.01, p = .815) | ||
WB (×109 L)
| 5.43 [4.32;6.63] | 5.23 [4.46;6.67] | 0.766 | 0.97 (0.88–1.07, p = .545) | ||
Creatinine (umol/L)
| 74.0 [63.0;83.0] | 73.0 [63.5;81.0] | 0.535 | 0.99 (0.98–1.01, p = .410) | ||
ALB (g/L)
| 41.4 [39.0;43.8] | 40.9 [38.7;43.2] | 0.639 | 1.00 (0.95–1.06, p = .858) | ||
TBIL (umol/L)
| 12.0 [8.85;15.9] | 11.6 [8.15;16.5] | 0.665 | 1.00 (0.98–1.02, p = .976) | ||
ASA: | 0.939 | |||||
I + II | 140 (70.4%) | 85 (71.4%) | 1 reference | |||
III | 59 (29.6%) | 34 (28.6%) | 0.95 (0.58–1.57, p = .838) | |||
Surgical approach
| 0.005 | |||||
Laparoscopic technique | 71 (35.7%) | 24 (20.2%) | 1 reference | 1 reference | 1 reference | |
Open | 128 (64.3%) | 95 (79.8%) | 2.20 (1.29–3.74, p = .004) | 2.01 (1.12–3.59, p = .018) | 2.01 (1.14–3.56, p = .016) | |
Extent of operation
| < 0.001 | |||||
Single segmentectomy | 97 (48.7%) | 42 (35.3%) | 1 reference | 1 reference | 1 reference | |
Two combined segmentectomies | 81 (40.7%) | 41 (34.5%) | 1.17 (0.69–1.97, p = .557) | 1.05 (0.61–1.83, p = .858) | 1.05 (0.61–1.83, p = .857) | |
Major hepatectomy | 21 (10.6%) | 36 (30.3%) | 3.96 (2.07–7.57, p < .001) | 3.48 (1.71–7.08, p < .001) | 3.48 (1.73–7.03, p < .001) | |
Surgical time (minute)
| 271 [222;330] | 270 [210;335] | 0.703 | 1.00 (1.00–1.00, p = .468) | ||
Blood volume intraoperative (per 100ml)
| 200 [100;500] | 400 [200;600] | < 0.001 | 1.12 (1.06–1.19, p < .001) | 1.08 (1.01–1.15, p = .016) | 1.08 (1.02–1.15, p = .006) |
Any postoperative complication
| < 0.001 | |||||
No | 153 (76.9%) | 68 (57.1%) | 1 reference | 1 reference | ||
Yes | 46 (23.1%) | 51 (42.9%) | 2.49 (1.53–4.07, p < .001) | 1.01 (0.54–1.89, p = .974) |
Any postoperative complication | Predictors of any postoperative complication occurrence | |||||
---|---|---|---|---|---|---|
univariable | multivariable-1 | multivariable-2 | ||||
Variables | No (N = 221) | Yes (N = 97) | P | OR (95%CI) | OR (95%CI) | OR (95%CI) |
Group
| 0.001 | |||||
ERAS | 118 (53.4%) | 32 (33%) | 1 reference | 1 reference | 1 reference | |
Non-ERAS | 103 (46.6%) | 65 (67%) | 2.33 (1.41–3.83, p < .001) | 2.51 (1.30–4.84, p = .006) | 2.58 (1.37–4.89, p = .004) | |
Age at diagnosis
| 53.9 (10.4) | 57.5 (10.3) | 0.004 | 1.04 (1.01–1.06, p = .004) | 1.03 (1.00-1.07, p = .029) | 1.04 (1.01–1.07, p = .014) |
Sex
| < 0.001 | |||||
Female | 64 (29.0%) | 8 (8.25%) | 1 reference | 1 reference | 1 reference | |
Male | 157 (71.0%) | 89 (91.8%) | 4.54 (2.08–9.89, p < .001) | 3.91 (1.36–11.26, p = .011) | 4.30 (1.65–11.23, p = .003) | |
BMI
| 23.0 [20.9;24.8] | 23.4 [21.7;25.4] | 0.175 | 1.06 (0.98–1.15, p = .133) | ||
Education level
| 0.526 | |||||
No school/primary education | 58 (26.2%) | 21 (21.6%) | 1 reference | |||
Middle Education | 69 (31.2%) | 37 (38.1%) | 1.48 (0.78–2.81, p = .229) | |||
High education | 46 (20.8%) | 22 (22.7%) | 1.32 (0.65–2.69, p = .444) | |||
University education | 48 (21.7%) | 17 (17.5%) | 0.98 (0.46–2.06, p = .954) | |||
Comorbidity
| 0.044 | |||||
No | 196 (88.7%) | 77 (79.4%) | 1 reference | 1 reference | ||
Yes | 25 (11.3%) | 20 (20.6%) | 2.04 (1.07–3.88, p = .030) | 1.40 (0.59–3.32, p = .439) | ||
Chronic smoking
| 0.498 | |||||
No | 169 (76.5%) | 70 (72.2%) | 1 reference | |||
Yes | 52 (23.5%) | 27 (27.8%) | 1.25 (0.73–2.16, p = .414) | |||
Chronic drinking
| 0.187 | |||||
No | 194 (87.8%) | 79 (81.4%) | 1 reference | |||
Yes | 27 (12.2%) | 18 (18.6%) | 1.64 (0.85–3.14, p = .138) | |||
ALT (U/L)
| 26.0 [20.0;33.0] | 26.0 [19.0;33.0] | 0.719 | 1.00 (0.97–1.03, p = .750) | ||
AST (U/L)
| 24.0 [17.0;30.0] | 26.0 [19.0;31.0] | 0.264 | 1.02 (0.99–1.05, p = .265) | ||
PLT (×109 L)
| 196 [142;241] | 179 [133;232] | 0.341 | 1.00 (0.99-1.00, p = .322) | ||
HB (g/L)
| 137 [125;151] | 141 [128;150] | 0.926 | 1.00 (0.99–1.01, p = .835) | ||
WB (×109 L)
| 5.38 [4.32;6.57] | 5.44 [4.59;7.05] | 0.316 | 1.06 (0.97–1.17, p = .208) | ||
Creatinine (umol/L)
| 72.0 [61.0;82.0] | 75.0 [67.0;84.0] | 0.013 | 1.02 (1.00-1.03, p = .028) | 1.00 (0.98–1.03, p = .729) | |
ALB (g/L)
| 41.4 [39.3;43.9] | 40.4 [38.5;42.9] | 0.037 | 0.95 (0.90–1.01, p = .077) | ||
TBIL (umol/L)
| 11.5 [8.70;15.5] | 12.7 [8.50;16.6] | 0.371 | 1.00 (0.98–1.02, p = .805) | ||
ASA: | 0.617 | |||||
I + II | 154 (69.7%) | 71 (73.2%) | 1 reference | |||
III | 67 (30.3%) | 26 (26.8%) | 0.84 (0.49–1.43, p = .526) | |||
Surgical approach
| < 0.001 | |||||
Laparoscopic technique | 82 (37.1%) | 13 (13.4%) | 1 reference | 1 reference | 1 reference | |
Open | 139 (62.9%) | 84 (86.6%) | 3.81 (2.00-7.26, p < .001) | 3.07 (1.42–6.63, p = .004) | 3.12 (1.45–6.72, p = .004) | |
Extent of operation
| < 0.001 | |||||
Single segmentectomy | 109 (49.3%) | 30 (30.9%) | 1 reference | 1 reference | 1 reference | |
Two combined segmentectomies | 86 (38.9%) | 36 (37.1%) | 1.52 (0.87–2.67, p = .143) | 1.43 (0.71–2.87, p = .312) | 1.43 (0.71–2.84, p = .314) | |
Major hepatectomy | 26 (11.8%) | 31 (32.0%) | 4.33 (2.24–8.38, p < .001) | 2.74 (1.18–6.37, p = .019) | 2.84 (1.23–6.56, p = .014) | |
Surgical time (minute)
| 267 [217;315] | 285 [218;359] | 0.053 | 1.00 (1.00-1.01, p = .004) | 1.00 (1.00–1.00, p = .974) | |
Blood volume intraoperative (per 100ml)
| 200 [100;400] | 500 [300;1100] | < 0.001 | 1.40 (1.27–1.54, p < .001) | 1.37 (1.23–1.52, p < .001) | 1.36 (1.23–1.50, p < .001) |