Enhanced recovery in the resection of colorectal liver metastases

Background There is limited evidence for the use of enhanced recovery after surgery (ERAS) in patients undergoing hepatectomy, and the impact of the evolution of ERAS over time has not been examined. This study sought to evaluate the effect of an evolving ERAS program in patients undergoing hepatect...

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Bibliographic Details
Published in:Journal of surgical oncology 2014-08, Vol.110 (2), p.197-202
Main Authors: Dunne, Declan F. J., Yip, Vincent S., Jones, Robert P., McChesney, Ewan A., Lythgoe, Daniel T., Psarelli, Eftychia E., Jones, Louise, Lacasia-Purroy, Carmen, Malik, Hassan Z., Poston, Graeme J., Fenwick, Stephen W.
Format: Article
Language:English
Subjects:
Aged
colorectal liver metastasis
Colorectal Neoplasms - pathology
Critical Care - statistics & numerical data
Critical Care - utilization
enhanced recovery
ERAS
fast track
Female
Guideline Adherence - statistics & numerical data
Hepatectomy
Humans
Kaplan-Meier Estimate
Length of Stay
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Logistic Models
Male
Metastasis
Middle Aged
Multivariate Analysis
Odds Ratio
Patient Discharge - standards
Perioperative Care - methods
Postoperative Complications - epidemiology
Practice Guidelines as Topic
Proportional Hazards Models
Recovery of Function
Retrospective Studies
Treatment Outcome
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Summary:Background There is limited evidence for the use of enhanced recovery after surgery (ERAS) in patients undergoing hepatectomy, and the impact of the evolution of ERAS over time has not been examined. This study sought to evaluate the effect of an evolving ERAS program in patients undergoing hepatectomy for colorectal liver metastases (CRLM). Methods A multimodal ERAS program was introduced in 2/2008. Consecutive patients undergoing hepatectomy for CRLM between 2/2008 and 9/2012 were included in the study. Data were collected prospectively. Retrospective analysis compared an early ERAS cohort (2/2008–4/2010) with a later cohort with a matured ERAS program (5/2010–8/2012). Results Length of stay reduced as experience of ERAS increased (Log‐rank χ2 = 10.43, P = 0.001). Although median length of stay remained unchanged (6 days), the probability of hospitalization beyond 10 days was 25% in the early cohort compared with 7% in the later cohort. Critical care utilization reduced over time (75.5% vs. 54.7%, P 
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.23616