RCT enhanced recovery versus standard care following open liver resection

Patient population
Open Liver Surgery.

LiDCO Monitor
LiDCOrapid as part of an enhanced recovery program (ERP).

Trial Design
Randomised ERP vs standard care.

Outcome Impact
LOS reduced by 3 days. Complications reduced from 27% to 7%.

BACKGROUND
Enhanced recovery programmes (ERPs) have been shown to reduce length of hospital stay (LOS) and complications in colorectal surgery. Whether ERPs have the same benefits in open liver resection surgery is unclear, and randomised clinical trials are lacking.

METHODS
Consecutive patients scheduled for open liver resection were randomised to an ERP group or standard care. Primary endpoints were time until medically fit for discharge (MFD) and LOS. Secondary endpoints were post-operative morbidity, pain scores, readmission rate, mortality, quality of life (QoL) and patient satisfaction. ERP elements included greater preoperative education, preoperative oral carbohydrate loading, post-operative goal-directed fluid therapy, early mobilization and physiotherapy. Both groups received standardized anesthesia with epidural analgesia.

RESULTS
The analysis included 46 patients in the ERP group and 45 in the standard care group. Median MFD time was reduced in the ERP group (3 days versus 6 days with standard care; P < 0·001), as was LOS (4 days versus 7 days; P < 0·001). The ERP significantly reduced the rate of medical complications (7 versus 27 per cent; P = 0·020), but not surgical complications (15 versus 11 per cent; P = 0·612), readmissions (4 versus 0 per cent; P = 0·153) or mortality (both 2 per cent; P = 0·987). QoL over 28 days was significantly better in the ERP group (P = 0·002). There was no difference in patient satisfaction.

CONCLUSION
ERPs for open liver resection surgery are safe and effective. Patients treated in the ERP recovered faster, were discharged sooner, and had fewer medical-related complications and improved QoL.

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