ArticleBJS open2026
Enhanced recovery after surgery compliance and postoperative outcomes after liver resection: retrospective cohort study.
Article in BJS open, 2026. 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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Abstract
backgroundEnhanced recovery after surgery (ERAS) pathways improve postoperative outcomes across surgical specialties, but the impact of ERAS compliance on outcomes after liver resection remains unclear. A retrospective cohort study of consecutive patients undergoing liver resection in an ERAS-certified centre was conducted to examine the association between overall and item-specific ERAS compliance and postoperative morbidity and length of hospital stay (LOS).
methodsThis retrospective cohort included elective liver resections performed between 2020 and 2024 at an ERAS-certified centre of excellence. ERAS compliance was prospectively recorded and categorized as high (≥ 70%) versus low/moderate (< 70%). Primary outcomes were any postoperative complication, major morbidity (Clavien-Dindo grade ≥ IIIa), and LOS; these were assessed by univariable and multivariable analyses, including a sensitivity analysis using an early compliance score excluding postoperative items.
resultsData from 637 consecutive liver resections were analysed. Mean (standard deviation) overall ERAS compliance was 64.0 (10.2%) and remained stable over time. High compliance was associated with fewer complications (51% (104) versus 69.8% (303); odds ratio (OR) 0.45; 95% confidence interval (c.i.) 0.30 to 0.67; P < 0.001), lower major morbidity (7.25% (15) versus 12.8% (55); OR 0.25, 95% c.i. 0.10 to 0.64; P = 0.001), and shorter LOS (7.42 versus 10.62 days; mean difference -3.21 days; P < 0.001). In multivariable analyses, high overall compliance was associated with major morbidity (OR 0.16; 95% c.i. 0.04 to 0.56; P = 0.005). Minimally invasive surgery independently decreased overall complications (OR 0.41; 95% c.i. 0.21 to 0.75; P = 0.005), major morbidity (OR 0.13; 95% c.i. 0.01 to 0.66; P = 0.050), and LOS (β = -2.31 days; P = 0.020). In sensitivity analyses, high compliance remained associated with fewer complications (OR 0.62; 95% c.i. 0.40 to 0.96; P = 0.035). Higher intraoperative intravenous fluid volume independently predicted morbidity and prolonged LOS (P < 0.001).
conclusionHigher ERAS compliance after liver resection is associated with lower severe morbidity and shorter LOS. Prioritizing potentially high-impact items may maximize recovery benefits.
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