Impact of enhanced recovery program implementation on postoperative outcomes after liver surgery: a monocentric retrospective study.

INTRODUCTION: It is still unclear whether enhanced recovery programs (ERPs) reduce postoperative morbidity after liver surgery. This study investigated the effect on liver surgery outcomes of labeling as a reference center for ERP. MATERIALS AND METHODS: Perioperative data from 75 consecutive patients who underwent hepatectomy in our institution after implementation and labeling of our ERP were retrospectively compared to 75 patients managed before ERP. Length of hospital stay, postoperative complications, and adherence to protocol were examined. RESULTS: Patient demographics, comorbidities, and intraoperative data were similar in the two groups. Our ERP resulted in shorter length of stay (3 days [1-6] vs. 4 days [2-7.5], p = 0.03) and fewer postoperative complications (24% vs. 45.3%, p = 0.0067). This reduction in postoperative morbidity can be attributed exclusively to a lower rate of minor complications (Clavien-dindo grade < IIIa), and in particular to a lower rate of postoperative ileus, after labeling. (5.3% vs. 25.3%, p = 0.0019). Other medical and surgical complications were not significantly reduced. Adherence to protocol improved after labeling (17 [16-18] vs. 14 [13-16] items, p < 0.001). CONCLUSIONS: The application of a labeled enhanced recovery program for liver surgery was associated with a significant shortening of hospital stay and a halving of postoperative morbidity, mainly ileus.

[Enhanced recovery after surgery of the elderly in colorectal surgery]. / Cas clinique. Réhabilitation améliorée de la personne âgée bénéficiant d'une chirurgie colorectale.

The concept of enhanced recovery in colorectal surgery is a multimodal and multidisciplinary programme aiming at reducing surgical stress through optimization of patient care in the pre-, intra-, and postoperative periods. It allows to reduce postoperative morbidity and the duration of the hospital stay. We describe the case of an elderly patient with multiple comorbidities who was scheduled for a sigmoidectomy in an enhanced rehabilitation programme, and emphasize the interest and specificity of such a rehabilitation protocol for the elderly.

La réhabilitation améliorée en chirurgie colorectale est un programme multimodal et pluridisciplinaire qui a pour but de réduire le stress chirurgical et ses conséquences en optimisant la prise en charge pré-, per-, et postopératoire des patients. Elle permet, d'une part, de diminuer nettement la morbidité postopératoire, et d'autre part, de raccourcir la durée et le coût du séjour hospitalier. Nous décrivons ici la prise en charge d'un patient âgé aux multiples comorbidités ayant bénéficié d'une sigmoïdectomie et ainsi du protocole institutionnel de réhabilitation améliorée du CHU de Liège. Elle nous permet de mettre en lumière les spécificités et les intérêts de l'application d'un tel protocole à la prise en charge de tout patient chirurgical.