IMPACT OF ENHANCED RECOVERY PROGRAM FOR HEPATECTOMY ON POSTOPERATIVE MORBIDITY AND LENGTH OF HOSPITAL STAY

Objectives : Some studies using selected patients suggest that enhanced recovery programs for liver surgery is associated with a significant reduction in postoperative complications and a shorter length of hospital stay as compared to standard care. In December 2020, enhanced recovery programs was formally applied for all unselected hepatic surgery patients in our institution labelled as GRACE reference center. This study aimed at determining the impact of enhanced recovery programs on postoperative complications and length of hospital stay. Methods : Data (outcomes, length of hospital stay, adherence to protocol [21 items]) from our first 52 patients prospectively entered in our GRACE database were analysed and compared to the last 75 patients scheduled for hepatectomy before enhanced recovery programs implementation. Data (median [IQR] or count (%)) were compared using Mann Whitney test or chi2 when appropriate. P < 0.05 = significant. Results : Patients demographic data and indications for surgery were similar in both groups. Adherence to enhanced recovery programs was 14 [13-16] before program implementation and 17 [16-18] after (p < 0.001). Items whose adherence rates were the most optimized after program implementation were early mobilization (p < 0.001), early refeeding (p = 0.001) and the absence of a urinary catheter at the end of surgery (p < 0.001). Complication rate was 45.3% vs 25.5%, respectively before and after enhanced recovery programs implementation (p = 0.024). Length of hospital stay was 4 [2-7.5] vs 3 [1-6] days respectively before and after labelling (p = 0.09). Conclusions : Our results demonstrate that enhanced recovery programs for hepatectomy in unselected patients resulted in a 40-50% reduction of postoperative complications and probably in shorter length of stay (power currently insufficient).