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
. 2024 Apr 1;13(1):24.
doi: 10.1186/s13741-024-00375-x.

Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis

Constant Delabays  1 , Nicolas Demartines  2 , Gaëtan-Romain Joliat #  1 , Emmanuel Melloul #  1
Affiliations

Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis

Constant Delabays et al. Perioper Med (Lond). .

Abstract

Background: Few studies have assessed enhanced recovery after surgery (ERAS) in liver surgery for cirrhotic patients. The present meta-analysis assessed the impact of ERAS pathways on outcomes after liver surgery in cirrhotic patients compared to standard care.

Methods: A literature search was performed on PubMed/MEDLINE, Embase, and the Cochrane Library. Studies comparing ERAS protocols versus standard care in cirrhotic patients undergoing liver surgery were included. The primary outcome was post-operative complications, while secondary outcomes were mortality rates, length of stay (LoS), readmissions, reoperations, and liver failure rates.

Results: After evaluating 41 full-text manuscripts, 5 articles totaling 646 patients were included (327 patients in the ERAS group and 319 in the non-ERAS group). Compared to non-ERAS care, ERAS patients had less risk of developing overall complications (OR 0.43, 95% CI 0.31-0.61, p < 0.001). Hospitalization was on average 2 days shorter for the ERAS group (mean difference - 2.04, 95% CI - 3.19 to - 0.89, p < 0.001). Finally, no difference was found between both groups concerning 90-day post-operative mortality and rates of reoperations, readmissions, and liver failure.

Conclusion: In cirrhotic patients, ERAS protocol for liver surgery is safe and decreases post-operative complications and LoS. More randomized controlled trials are needed to confirm the results of the present analysis.

Keywords: ERAS; Fibrosis; Hepatectomy; Hepatic resection; Perioperative care.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart of the study
Fig. 2
Fig. 2
Quality assessment using the Cochrane Collaboration tool. Risk of bias summary in controlled trials. The symbol (−) indicates that there is a high risk of bias, (+) indicates a low risk of bias, and (?) indicates uncertainty
Fig. 3
Fig. 3
Forest plots comparing complications between ERAS and the control group. a Forest plot comparing overall complications between the ERAS group and control group. b Forest plot comparing minor complications (Clavien < III) between ERAS group and the control group. c Forest plot comparing major complications (Clavien ≥ III) between ERAS group and control group
Fig. 4
Fig. 4
Funnel plot for risk of publication bias regarding overall post-operative complications
Fig. 5
Fig. 5
Forest plot comparing post-operative mortality between the ERAS group and control group
Fig. 6
Fig. 6
Forest plot comparing the length of stay between the ERAS group and the control group
Fig. 7
Fig. 7
Forest plot comparing the need for readmission between the ERAS group and control group
Fig. 8
Fig. 8
Forest plot comparing the need for reoperation between the ERAS group and control group
Fig. 9
Fig. 9
Forest plot comparing post-operative liver failure between the ERAS group and control group
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Agarwal V, Divatia JV. Enhanced recovery after surgery in liver resection: current concepts and controversies. Korean J Anesthesiol. 2019;72(2):119–29. doi: 10.4097/kja.d.19.00010. - DOI - PMC - PubMed
    1. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191(1):38–46. doi: 10.1016/S1072-7515(00)00261-1. - DOI - PubMed
    1. Bell R, Ward D, Jeffery J, Toogood GJ, Lodge JpA, Rao K, et al. A randomized controlled trial comparing epidural analgesia versus continuous local anesthetic infiltration via abdominal wound catheter in open liver resection. Ann Surg. 2019;269(3):413–9. doi: 10.1097/SLA.0000000000002988. - DOI - PubMed
    1. Benzoni E, Molaro R, Cedolini C, Favero A, Cojutti A, Lorenzin D, et al. Liver resection for HCC: analysis of causes and risk factors linked to postoperative complications. Hepatogastroenterology. 2007;54(73):186–9. - PubMed
    1. Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr. 2020;39(12):3533–62. doi: 10.1016/j.clnu.2020.09.001. - DOI - PubMed

LinkOut - more resources