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Second Generation of a Fast-track Liver Resection Programme

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Abstract

Background

Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over time of a modified previously published fast-track programme in unselected patients undergoing open or laparoscopic liver resection.

Methods

A prospective study includes the first 121 consecutive patients following an updated fast-track programme for liver resection. High-dose methylprednisolone was given to all patients before surgery, catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. The discharge criteria were (1) pain sufficiently controlled by oral analgesics only; (2) patient comfortable with discharge; (3) no untreated complications.

Results

The median length of stay (LOS) for all patients was 4 days, with 2 days after laparoscopic vs. 4 days for open resections. The median LOS after major hepatectomies (≥3 segments) was 5 days. The readmission rate was 6% and the 30-day mortality zero. The LOS decreased compared to our first-generation fast-track programme with LOS 5 days.

Conclusions

Fast-track principles for perioperative care and early discharge are safe even after major liver resection. The introduction of high-dose steroids preoperatively might have facilitated a shorter LOS. Routine discharge on POD 1 or 2 after laparoscopic resection and on POD 4 after open liver resection has proven to be feasible.

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Acknowledgements

We thank our anaesthesiologist colleagues and all involved surgeons and staff at Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Nicolai A. Schultz, Peter N. Larsen, B. Klarskov, L. M. Plum & Jens G. Hillingsø

  2. Department of Anaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Hans-Jørgen Frederiksen

  3. Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Henrik Kehlet

Authors
  1. Nicolai A. Schultz
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  2. Peter N. Larsen
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  3. B. Klarskov
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  4. L. M. Plum
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  5. Hans-Jørgen Frederiksen
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  6. Henrik Kehlet
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Correspondence to Jens G. Hillingsø.

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Schultz, N.A., Larsen, P.N., Klarskov, B. et al. Second Generation of a Fast-track Liver Resection Programme. World J Surg 42, 1860–1866 (2018). https://doi.org/10.1007/s00268-017-4399-3

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  • DOI: https://doi.org/10.1007/s00268-017-4399-3

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