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Impact of 2016 Enhanced Recovery After Surgery (ERAS) Recommendations on Outcomes after Hepatectomy in Cirrhotic and Non-Cirrhotic Patients

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Abstract

Background

The Enhanced Recovery After Surgery (ERAS) society published new recommendations for hepatectomy in 2016. Few studies have assessed their clinical impact. The aim of this monocentric study was to assess the impact of those guidelines on outcomes after liver surgery with a special focus on cirrhotic patients.

Method

Postoperative outcomes of patients undergoing hepatectomy 30 months before and after ERAS implementation according to the 2016 ERAS guidelines were compared after inverse probability of treatment weighting (IPTW). Primary endpoint was 90-day morbidity.

Results

From 2015 to 2020, 430 patients underwent hepatectomy including 226 procedures performed before and 204 after ERAS implementation. After IPTW, overall morbidity (42.5% vs. 64.7%, p < 0.001), Comprehensive Complication Index (CCI) score (14.3 vs. 20.8, p = 0.004), length of stay (10.4 vs. 13.7 days, p = 0.001) and textbook outcome (50% vs. 40.2%, p = 0.022) were significantly improved in the ERAS group, while mortality and severe complications were similar in both groups. In the non-cirrhosis subgroup (n = 321), these results were confirmed. However, in the cirrhosis subgroup (n = 105), no difference appeared on outcomes after hepatectomy with an overall morbidity (47.5% vs. 65.2%, p = 0.069) and a length of stay (8 vs. 9 days, p = 0.310) which were not significantly different. The compliance rate to ERAS guidelines was 60% in both cirrhotic and non-cirrhotic subgroups.

Conclusion

Perioperative ERAS program for hepatectomy results in improved outcomes with decreased rate of non-severe morbidity. Although those guidelines are not deleterious for cirrhotic patients, they probably require revisions to be more effective in this patient population.

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Authors and Affiliations

  1. Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France

    Thibault Lunel, Kayvan Mohkam, Paul-Noël Dumont, Christian Ducerf, Jean-Yves Mabrut & Mickaël Lesurtel

  2. Hepatology Unit, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France

    Philippe Merle

  3. Department of Anesthesiology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France

    Aurélie Bonnet & Mathieu Gazon

Authors
  1. Thibault Lunel
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  2. Kayvan Mohkam
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  3. Philippe Merle
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  4. Aurélie Bonnet
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  6. Paul-Noël Dumont
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Correspondence to Mickaël Lesurtel.

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Conflict of interest

Philippe Merle has served on the advisory board of Roche, AstraZeneca, Ipsen, MSD, Eisai, Bayer, and Lilly. He has also served as a consultant for Ipsen, Eisai, and Onxeo and received grants from Ipsen and Onxeo. The other authors declare that they have no conflict of interests.

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This study was supported by Antonin Poncet grant from the University of LYON 1 dedicated to Paul-Noël Dumont.

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Lunel, T., Mohkam, K., Merle, P. et al. Impact of 2016 Enhanced Recovery After Surgery (ERAS) Recommendations on Outcomes after Hepatectomy in Cirrhotic and Non-Cirrhotic Patients. World J Surg 45, 2964–2974 (2021). https://doi.org/10.1007/s00268-021-06229-7

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  • DOI: https://doi.org/10.1007/s00268-021-06229-7

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