Impact of Enhanced Recovery After Surgery on Long-Term Outcomes and Postoperative Recovery in Patients Undergoing Hepatectomy: A Retrospective Cohort Study
Authors Zhang Z, Gu W, Zhang Y
Received 16 January 2021
Accepted for publication 25 February 2021
Published 19 March 2021 Volume 2021:13 Pages 2681—2690
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Eileen O'Reilly
Zhao Zhang,1 Weidong Gu,2 Yijing Zhang2
1Nursing Department, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China; 2Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People’s Republic of China
Correspondence: Yijing Zhang
Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai, 200040, People’s Republic of China
Email [email protected]
Background: The aim of this study was to evaluate the effects of implementation of the enhanced recovery after surgery (ERAS) program on postoperative recovery and the long-term prognosis in patients who underwent hepatectomy.
Methods: This retrospective study enrolled patients who underwent hepatectomy from January 2015 to December 2018 in Huadong Hospital Affiliated to Fudan University. Since June 2016, a 24-point ERAS protocol has been implemented for patients who underwent hepatic resection. The primary outcomes were overall survival (OS) and disease-free survival (DFS). The secondary outcomes included length of stay (LOS), and incidence of postoperative complications.
Results: A total of 1143 patients were enrolled in this study. After propensity score matching (PSM), there was no significant difference in patients’ demographic characteristics. The DFS at 1., 3 years in ERAS group was higher than in non-ERAS group (96.3% vs 88.9% for 1 year, P=0.012; 58.9% vs 46.7% for 3 years, P=0.007). The OS at 1, 3 years in ERAS group was higher than in non-ERAS group (93.1% vs 89.3% for 1 year, P=0.041; 68.7% vs 61.2% for 3 years, P=0.035). In addition, the patients in ERAS group had lower incidences of postoperative hemorrhage, bile leak, and postoperative deep vein thrombosis/pulmonary embolism (DVT/PE), decreased 30-day readmission rate and total readmission rate, and shorter LOS.
Conclusion: ERAS program could be safely applied to patients who underwent hepatectomy thereby improving their recovery and prolonging OS and DFS.
Keywords: hepatectomy, enhanced recovery after surgery, length of stay, overall survival, disease-free survival
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