Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Mar 7;11(3):e0150782.
doi: 10.1371/journal.pone.0150782. eCollection 2016.

Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection

Clancy J Clark  1 , Shahzad M Ali  2 , Victor Zaydfudim  3 , Adam K Jacob  4 , David M Nagorney  2
Affiliations

Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection

Clancy J Clark et al. PLoS One. .

Abstract

Background: Enhanced recovery pathways (ERP) have not been widely implemented for hepatic surgery. The aim of this study was to evaluate the safety of an ERP for patients undergoing open hepatic resection.

Methods: A single-surgeon, retrospective observational cohort study was performed comparing the clinical outcomes of patients undergoing open hepatic resection treated before and after implementation of an ERP. Morbidity, mortality, and length of hospital stay (LOS) were compared between pre-ERP and ERP groups.

Results: 126 patients (pre-ERP n = 73, ERP n = 53) were identified for the study. Patient characteristics and operative details were similar between groups. Overall complication rate was similar between pre-ERP and ERP groups (37% vs. 28%, p = 0.343). Before and after pathway implementation, the median LOS was similar, 5 (IQR 4-7) vs. 5 (IQR 4-6) days, p = 0.708. After adjusting for age, type of liver resection, and ASA, the ERP group had no increased risk of major complication (OR 0.38, 95% CI 0.14-1.02, p = 0.055) or LOS greater than 5 days (OR 1.21, 95% CI 0.56-2.62, p = 0.627).

Conclusions: Routine use of a multimodal ERP is safe and is not associated with increased postoperative morbidity after open hepatic resection.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Lemmens L, van Zelm R, Borel Rinkes I, van Hillegersberg R, Kerkkamp H. Clinical and organizational content of clinical pathways for digestive surgery: a systematic review. Dig Surg. 2009;26: 91–9. 10.1159/000206142 - DOI - PubMed
    1. Bradshaw BG, Liu SS, Thirlby RC. Standardized perioperative care protocols and reduced length of stay after colon surgery. J Am Coll Surg. 1998;186: 501–6. Available: http://www.ncbi.nlm.nih.gov/pubmed/9583689. - PubMed
    1. Tsikitis VL, Holubar SD, Dozois EJ, Cima RR, Pemberton JH, Larson DW. Advantages of fast-track recovery after laparoscopic right hemicolectomy for colon cancer. Surg Endosc. 2010;24: 1911–6. 10.1007/s00464-009-0871-y - DOI - PubMed
    1. Porter GA, Pisters PW, Mansyur C, Bisanz A, Reyna K, Stanford P, et al. Cost and utilization impact of a clinical pathway for patients undergoing pancreaticoduodenectomy. Ann Surg Oncol. 2000;7: 484–9. Available: http://www.ncbi.nlm.nih.gov/pubmed/10947015. - PubMed
    1. Balcom JH, Rattner DW, Warshaw a L, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001;136: 391–8. Available: http://www.ncbi.nlm.nih.gov/pubmed/11296108. - PubMed

LinkOut - more resources