Research On The Implementation Of Enhanced Recovery After Surgery (ERAS) Program In The Perioperative Period Of Hepatectomy

Background and purposeHepatectomy is mainly used in the benign and malignant liver tumors,including hepatocellular carcinoma and colorectal liver metastases.Hepatectomy is considered as a challenging major abdominal surgery with extreme impact on patient physiology,because of the complex procedures,large region of operation,long operation time,intraoperative tissue damage and overactive inflammation after surgery.Although the development of surgical techniques and the improvement of surgical instruments have reduced the mortality of hepatectomy,but the postoperative morbidity and mortality rates still remain high.The concept of Enhanced recovery after surgery(ERAS)was first introduced by Kehlet in 1997 and then has widely implemented in the perioperative period of multiple surgeries.ERAS contains a series of effective methods,mainly including preoperative counseling,perioperative anesthesia administration and postoperative mobilization,to reduce the inflammatory response and promote functional recovery.ERAS can effectively alleviate the psychological and physiological trauma;reduce the surgical stress response;accelerate intestine functional recovery,thus to reduce the postoperative morbidity and mortality rates;shorten the duration of postoperative hospital stay;reduce hospital cost.Is has been proved that ERAS is beneficial in colorectal,gastric and urologic surgeries.However,data on the implementation of ERAS in hepatectomy still remains rare.In this study,we conducted a retrospective study of 121 patients undergoing hepatectomy in Nanfang Hospital to investigate the effects of enhanced recovery program(ERAS)implemented in the perioperative period of hepatectomy.MethodsWe retrospectively investigated the medical records of 121 patients who had undergone hepatectomy during the period of January 2015 to September 2016 in Nanfang Hospital.62 patients in the ERAS group were guided by ERAS principles,while 59 patients in the control group were managed with traditional methods.They were compared in terms of operation method,operation level,operation time,volume of intraoperative blood loss,pathology,time to flatus,time to drainage tube removal,time to urinary tube removal,duration of postoperative hospital stay,complications,30-days readmissions.THE changes of C-reactive protein(CRP),leukocytes,polymorphonuclear leucocytes,total bilirubin,aspartate aminotransferase(AST),anineamiotransferase(ALT)were recorded.Comparison of categorical variables was performed using the Chi-square test or independent samples t-test.The median and ranges of continuous parameters were compared using the Mann-Whitney U test.ResultsAll patients were cured without perioperative death.The leukocytes and polymorphonuclear leucocytes on postoperative day 1,3,5 in ERAS group were significantly less than in control group(p<0.05).The CRP on postoperative day 3,5 in ERAS group were significantly lower than in control group(p<0.05).The ALT on postoperative day 1,3,5 in ERAS group were significantly lower than in control group(p<0.05).The AST and TBIL on postoperative dayl,3 in ERAS group were significantly lower than in control group(p<0.05).The time of first flatus,drainage tube removal,urinary tube removal,duration of postoperative hospital stay were significantly reduced in ERAS group than in control group(p<0.05).There is no difference in readmission rate or surgical complications between ERAS group and control group.ConclusionERAS programs appear to be safe and feasible in the perioperative period of hepatectomy,which can effectively reduce inflammatory response and accelerated functional recovery.