RCT enhanced recovery versus standard care following open liver resection

Jones et al. 2013

LiDCOrapid as part of an enhanced recovery program (ERP) Randomised ERP vs. standard care showed reduced length of stay by 3 days and complications reduced from 27% to 7%.

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Patient Population
Open Liver Surgery.

Trial Design
Randomised ERP vs standard care.

Outcome Impact
LOS reduced by 3 days. Complications reduced from 27% to 7%.

LiDCO Monitor
LiDCOrapid as part of an enhanced recovery program (ERP).

BACKGROUND
Enhanced recovery programs (ERPs) have been shown to reduce the length of hospital stay (LOS) and complications in colorectal surgery. Whether ERPs have the same benefits in open liver resection surgery is unclear, and randomized clinical trials are lacking.

METHODS
Consecutive patients scheduled for open liver resection were randomized to an ERP group or standard care. Primary endpoints were time until medically fit for discharge (MFD) and LOS. Secondary endpoints were post-operative morbidity, pain scores, readmission rate, mortality, quality of life (QoL) and patient satisfaction. ERP elements included greater pre-operative education, pre-operative oral carbohydrate loading, post-operative goal-directed fluid therapy, early mobilization and physiotherapy. Both groups received standardized anesthesia with epidural analgesia.

RESULTS
The analysis included 46 patients in the ERP group and 45 in the standard care group. Median MFD time was reduced in the ERP group (3 days versus 6 days with standard care; P < 0·001), as was LOS (4 days versus 7 days; P < 0·001). The ERP significantly reduced the rate of medical complications (7 versus 27 percent; P = 0·020), but not surgical complications (15 versus 11 percent; P = 0·612), readmissions (4 versus 0 percent; P = 0·153) or mortality (both 2 per cent; P = 0·987). QoL over 28 days was significantly better in the ERP group (P = 0·002). There was no difference in patient satisfaction.

CONCLUSION
ERPs for open liver resection surgery are safe and effective. Patients treated in the ERP recovered faster, were discharged sooner, and had fewer medical-related complications and improved QoL.

Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott M J, Vandrevala T, Fry C H, Karanjia N and Quiney N.  Randomized clinical trial on enhanced recovery versus standard care following open liver resection.  Br J Surg 2013 Jul;100(8):1015-24.

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