ArticleSurgery2019
Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids.
Article in Surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- Analgesic efficacy of multiple regional nerve block techniques in laparoscopic hepatectomy: a systematic review and meta-analysis.BMC anesthesiology · 2026Pooled it
- Prolonged opioid use after surgery in children, adolescents, and young adults: a systematic review.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025Pooled it
- Integrated metabolomic insights into the mechanism ofFrontiers in immunology · 2025Trial
- Assessment of Ultrasound-Guided Continuous Low Serratus Anterior Plane Block for Pain Management After Hepatectomy: A Randomized Controlled Trial.Journal of pain research · 2023Trial
- Utilization and evolving prescribing practice of opioid and non-opioid analgesics in patients undergoing lymphadenectomy for cutaneous malignancy.Journal of surgical oncology · 2022Trial
- Review
- Persistent Improvement in Opioid Perceptions and Prescribing for Cancer Surgery: 5-Year Follow-Up.Advances in cancer education and quality improvement · 2025Article
- Impact of Nonhepatectomy Opioid Reduction Efforts on Posthepatectomy Opioid Prescription: Analysis of 2,005 Patients.Journal of the American College of Surgeons · 2025Article
- Risk-stratified posthepatectomy pathways based upon the Kawaguchi-Gayet complexity classification and impact on length of stay.Surgery open science · 2022Article
- Reducing New Persistent Opioid Use After Surgery: A Review of Interventions.Current pain and headache reports · 2021Review
- Opioid exposure after injury in United States trauma centers: A prospective, multicenter observational study.The journal of trauma and acute care surgery · 2020Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
backgroundPathways of enhanced recovery in liver surgery decrease inpatient opioid use; however, little data exist regarding their effect on discharge prescriptions and post-discharge opioid intake.
methodsFor consecutive patients undergoing liver resection from 2011-2018, clinicopathologic factors were compared between patients exposed to enhanced recovery vs. traditional care pathways. Multivariable analysis was used to determine factors predictive for traditional opioid use at the first postoperative follow-up. The enhanced recovery in liver surgery protocol included opioid-sparing analgesia, goal-directed fluid therapy, early postoperative feeding, and early ambulation.
resultsOf 244 cases, 147 enhanced recovery patients were compared with 97 traditional pathway patients. Enhanced recovery patients were older (median 57 years vs 52 years, P = .031) and more frequently had minimally invasive operations (37% vs 16%, P < .001), with fewer major complications (2% vs 9%, P = .011). Enhanced recovery patients were less likely to be discharged with a prescription for traditional opioids (26% vs 79%, P < .001) and less likely to require opioids at their first postoperative visit (19% vs 61%, P < .001) despite similarly low patient-reported pain scores (median 2/10 both groups, P = .500). On multivariable analysis, the traditional recovery pathway was independently associated with traditional opioid use at the first follow-up (odds ratio 6.4, 95% confidence interval 3.5-12.1; P < .001).
conclusionThe implementation of an enhanced recovery in liver surgery pathway with opioid-sparing techniques was associated with decreased postoperative discharge prescriptions for opioids and outpatient opioid use after oncologic liver surgery, while achieving the same level of pain control. For this and other populations at risk of persistent opioid use, enhanced recovery strategies can eliminate excess availability of opioids.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.