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World Journal of Surgery

, Volume 43, Issue 1, pp 230–241 | Cite as

Enhanced Recovery in Liver Transplantation: A Feasibility Study

  • Raffaele Brustia
  • Antoine Monsel
  • Filomena Conti
  • Eric Savier
  • Geraldine Rousseau
  • Fabiano Perdigao
  • Denis Bernard
  • Daniel Eyraud
  • Yann Loncar
  • Olivier Langeron
  • Olivier Scatton
Original Scientific Report
  • 171 Downloads

Abstract

Background

Enhanced Recovery After Surgery (ERAS) programmes after surgery are effective in reducing length of stay, functional recovery and complication rates in liver surgery (LS) with the indirect advantage of reducing hospitalisation costs. Preoperative comorbidities, challenging surgical procedures and complex post-operative management are the points that liver transplantation (LT) shares with LS. Nevertheless, there is little evidence regarding the feasibility and safety of ERAS programmes in LT.

Methods

We designed a pilot, small-scale, feasibility study to assess the impact on hospital stay, protocol compliance and safety of an ERAS programme tailored for LT. The ERAS arm was compared with a 1:2 match paired control arm with similar characteristics. All patients with MELD <25 were included. A dedicated LT-tailored protocol was derived from publications on ERAS liver surgery.

Results

Ten patients were included in the Fast-Trans arm. It was observed a 47% reduction of the total LOS, as compared to the control arm: 9.5 (9.0–10.5) days versus 18.0 (14.3–24.3) days, respectively, p <0.001. The protocol achieved 72.9% compliance. No differences were observed in terms of post-operative complications or readmission rates after discharge between the two arms. Overall, it was observed a reduction of length of stay in ICU and surgical ward in the Fast-Trans arm compared with the control arm.

Conclusion

Considered the main points in common between LS and LT, this small-scale study suggests that the application of an ERAS programme tailored to the LT setting is feasible. Further testing will be appropriate to generalise these findings.

Notes

Author contributions

OS, OL, AM and RB conceived and wrote the manuscript. All Authors were in charge of patients, revised and approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Supplementary material

268_2018_4747_MOESM1_ESM.doc (80 kb)
Supplementary material 1 (DOC 80 kb)

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Raffaele Brustia
    • 1
    • 4
  • Antoine Monsel
    • 2
    • 4
  • Filomena Conti
    • 3
    • 4
  • Eric Savier
    • 1
  • Geraldine Rousseau
    • 1
    • 4
  • Fabiano Perdigao
    • 1
  • Denis Bernard
    • 2
  • Daniel Eyraud
    • 2
  • Yann Loncar
    • 2
  • Olivier Langeron
    • 2
    • 4
  • Olivier Scatton
    • 1
    • 4
  1. 1.Liver Transplantation Surgical Programme and Hepatobiliary Surgical DepartmentHôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisParisFrance
  2. 2.Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical CareHôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisParisFrance
  3. 3.Liver Transplantation and Hepatology DepartmentHôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisParisFrance
  4. 4.Sorbonne UniversitésParisFrance

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