ArticleUpdates in surgery2025
Early compliance to enhanced recovery protocol as a predictor of complications after liver surgery.
Article in Updates in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundEnhanced Recovery Protocol (ERP) has the purpose of minimising postoperative hospitalisation and expediting the restoration of preoperative patient conditions. This study seeks to investigate the correlation between early non-compliance to postoperative items within ERP and complications in liver surgery.
methodsFrom January 2019 to December 2022 the ERP was proposed to all consecutive patients undergoing liver surgery. Nasogastric tube removal, resuming oral intake and mobilisation and obtaining an adequate glycaemic control were the postoperative items considered as non-compliance indicators. Data were prospectively collected and analysed.
results192 patients were included, comprising 99(51.6%) hepatocellular carcinoma, 58(30.2%) colorectal metastasis and 24(12.5%) benign/other pathology. A minimally invasive approach was adopted in 57.3% of cases. Postoperative morbidities occurred in 44.8% of patients, while major complications in 13% of patients. Cirrhosis (p < 0.001), minimally invasive approach (p < 0.004), early oral intake (p < 0.019) and early mobilisation (p < 0.019) significantly correlated to morbidity at multivariate analysis. The complication rate escalated from 26.9% in fully compliant patients, to 58% in patients with two non-compliance indicators and to 91.2% in fully non-compliant patients (p < 0.001). The same trend was confirmed for major complications (p < 0.001).
conclusionsEarly non-compliance to ERP postoperative items in liver surgery was significantly associated with overall and major morbidity.
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