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Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a Positive Impact on Non-ERAS Liver Surgery Patients

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Abstract

Background

Enhanced recovery after surgery (ERAS) reduces complications and hospital stay in colorectal surgery. Thereafter, ERAS principles were extended to liver surgery. Previous implementation of an ERAS program in colorectal surgery may influence patients undergoing liver surgery in a non-ERAS setting, on the same ward. This study aimed to test this hypothesis.

Methods

Retrospective analysis based on prospective data of the adherence to the institutional ERAS-liver protocol (compliance) in three cohorts of consecutive patients undergoing elective liver surgery, between June 2010 and July 2014: before any ERAS implementation (pre-ERAS n = 50), after implementation of ERAS in colorectal (intermediate n = 50), and after implementation of ERAS in liver surgery (ERAS-liver n = 74). Outcomes were functional recovery, postoperative complications, hospital stay, and readmissions.

Results

The three groups were comparable for demographics; laparoscopy was more frequent in ERAS-liver (p = 0.009). Compliance with the enhanced recovery protocol increased along the three periods (pre-ERAS, intermediate, and ERAS-liver), regardless of the perioperative phase (pre-, intra-, or postoperative). ERAS-liver group displayed the highest overall compliance rate with 73.8 %, compared to 39.9 and 57.4 % for pre-ERAS and intermediate groups (p = 0.072/0.056). Overall complications were unchanged (p = 0.185), whereas intermediate and ERAS-liver groups showed decreased major complications (p = 0.034). Consistently, hospital stay was reduced by 2 days (p = 0.005) without increased readmissions (p = 0.158).

Conclusions

The previous implementation of an ERAS protocol in colorectal surgery may induce a positive impact on patients undergoing non-ERAS-liver surgery on the same ward. These results suggest that ERAS is safely applicable in liver surgery and associated with benefits.

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Acknowledgments

The authors would like to acknowledge the support provided by all members of the enhanced recovery team in Lausanne, and especially the dedicated surgical nursing team with their leaders V. Addor, N. Zehnder, and A. Jannot. A particular attention is paid to the outstanding efforts and contribution achieved by V. Addor for the data management. Institutional financial support: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Switzerland.

Author contribution

Ismail Labgaa: conception and design, analysis, interpretation and writing. Ghada Jarrar: collection of data and interpretation. Gaetan-Romain Joliat: conception and design, interpretation and critical revision. Pierre Allemann: conception and design, interpretation and critical revision. Sylvain Gander: conception and design, interpretation and critical revision. Catherine Blanc: collection of data, interpretation and critical revision. Martin Hübner: conception and design, interpretation, drafting and critical revision. Nicolas Demartines: conception and design, interpretation and major editing.

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Author notes

    Authors and Affiliations

    1. Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland

      Ismail Labgaa, Ghada Jarrar, Gaëtan-Romain Joliat, Pierre Allemann, Martin Hübner & Nicolas Demartines

    2. Department of Anesthesiology, Hospital of Yverdon-Les-Bains, Yverdon-Les-Bains, Switzerland

      Sylvain Gander

    3. Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland

      Catherine Blanc

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    1. Ismail Labgaa
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    Correspondence to Nicolas Demartines.

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    The authors declare no conflicts of interests and no sources of support and funding for this work.

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    Ismail Labgaa and Ghada Jarrar have contributed equally.

    Appendix

    Appendix

    See Fig. 5.

    Fig. 5
    figure 5

    Compliance rate of each ERAS items fro the three comparative groups. The bars indicate the percentage of patients who adhered to the individual measures of the ERAS protocol. Results are presented for the three comparative groups “pre-ERAS (green)”, “intermediate (red)” and ERAS-liver (blue). Asterisk indicates statistical significance: p < 0.05

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    Labgaa, I., Jarrar, G., Joliat, GR. et al. Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a Positive Impact on Non-ERAS Liver Surgery Patients. World J Surg 40, 1082–1091 (2016). https://doi.org/10.1007/s00268-015-3363-3

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