Enhanced Recovery Programs in Liver Surgery

Excerpt

In the study of Applicability of an Enhanced Recovery Program for Advanced Liver Surgery by a reknowned Japanese group, results are presented on using an enhanced recovery after surgery program in major liver surgery [1]. Takamoto et al. used recovery status on postoperative day 6 as the outcome measure, which was defined as independence from continuous medical intervention, with the exception of an abdominal drain. The authors show that it is feasible to apply an enhanced recovery after surgery (ERAS) program to major liver surgery. Over 80 % of the patients completed the program, and most of them achieved recovery by day 6 without an increase in morbidity or mortality. These results were obtained using a fairly conservative ERAS program with bowel preparation, oral intake commencing only on day 3, and intravenous feeding and epidural analgesia continuing until postoperative day 5. The authors are to be applauded for their excellent results. Although early discharge was not achieved because of restrictions imposed by the Japanese health care system, the study confirms that enhanced recovery programs are feasible and safe in major liver surgery. Equally, the study draws attention to the fact that time to recovery is a far more important and better outcome measure than time to discharge from the hospital. The latter is profoundly influenced by many factors that have little to do with patient recovery [2]. …