Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis
Abstract Background Few studies have assessed enhanced recovery after surgery (ERAS) in liver surgery for cirrhotic patients. The present meta-analysis assessed the impact of ERAS pathways on outcomes after liver surgery in cirrhotic patients compared to standard care. Methods A literature search wa...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-04-01
|
| Series: | Perioperative Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13741-024-00375-x |
| _version_ | 1797219690513170432 |
|---|---|
| author | Constant Delabays Nicolas Demartines Gaëtan-Romain Joliat Emmanuel Melloul |
| author_facet | Constant Delabays Nicolas Demartines Gaëtan-Romain Joliat Emmanuel Melloul |
| author_sort | Constant Delabays |
| collection | DOAJ |
| description | Abstract Background Few studies have assessed enhanced recovery after surgery (ERAS) in liver surgery for cirrhotic patients. The present meta-analysis assessed the impact of ERAS pathways on outcomes after liver surgery in cirrhotic patients compared to standard care. Methods A literature search was performed on PubMed/MEDLINE, Embase, and the Cochrane Library. Studies comparing ERAS protocols versus standard care in cirrhotic patients undergoing liver surgery were included. The primary outcome was post-operative complications, while secondary outcomes were mortality rates, length of stay (LoS), readmissions, reoperations, and liver failure rates. Results After evaluating 41 full-text manuscripts, 5 articles totaling 646 patients were included (327 patients in the ERAS group and 319 in the non-ERAS group). Compared to non-ERAS care, ERAS patients had less risk of developing overall complications (OR 0.43, 95% CI 0.31–0.61, p < 0.001). Hospitalization was on average 2 days shorter for the ERAS group (mean difference − 2.04, 95% CI − 3.19 to − 0.89, p < 0.001). Finally, no difference was found between both groups concerning 90-day post-operative mortality and rates of reoperations, readmissions, and liver failure. Conclusion In cirrhotic patients, ERAS protocol for liver surgery is safe and decreases post-operative complications and LoS. More randomized controlled trials are needed to confirm the results of the present analysis. |
| first_indexed | 2024-04-24T12:37:39Z |
| format | Article |
| id | doaj.art-c69072197abe4a6fa557c29d0f66780e |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-04-24T12:37:39Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-c69072197abe4a6fa557c29d0f66780e2024-04-07T11:25:44ZengBMCPerioperative Medicine2047-05252024-04-0113111210.1186/s13741-024-00375-xEnhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysisConstant Delabays0Nicolas Demartines1Gaëtan-Romain Joliat2Emmanuel Melloul3Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL)Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL)Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL)Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL)Abstract Background Few studies have assessed enhanced recovery after surgery (ERAS) in liver surgery for cirrhotic patients. The present meta-analysis assessed the impact of ERAS pathways on outcomes after liver surgery in cirrhotic patients compared to standard care. Methods A literature search was performed on PubMed/MEDLINE, Embase, and the Cochrane Library. Studies comparing ERAS protocols versus standard care in cirrhotic patients undergoing liver surgery were included. The primary outcome was post-operative complications, while secondary outcomes were mortality rates, length of stay (LoS), readmissions, reoperations, and liver failure rates. Results After evaluating 41 full-text manuscripts, 5 articles totaling 646 patients were included (327 patients in the ERAS group and 319 in the non-ERAS group). Compared to non-ERAS care, ERAS patients had less risk of developing overall complications (OR 0.43, 95% CI 0.31–0.61, p < 0.001). Hospitalization was on average 2 days shorter for the ERAS group (mean difference − 2.04, 95% CI − 3.19 to − 0.89, p < 0.001). Finally, no difference was found between both groups concerning 90-day post-operative mortality and rates of reoperations, readmissions, and liver failure. Conclusion In cirrhotic patients, ERAS protocol for liver surgery is safe and decreases post-operative complications and LoS. More randomized controlled trials are needed to confirm the results of the present analysis.https://doi.org/10.1186/s13741-024-00375-xHepatectomyPerioperative careERASHepatic resectionFibrosis |
| spellingShingle | Constant Delabays Nicolas Demartines Gaëtan-Romain Joliat Emmanuel Melloul Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis Perioperative Medicine Hepatectomy Perioperative care ERAS Hepatic resection Fibrosis |
| title | Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis |
| title_full | Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis |
| title_fullStr | Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis |
| title_full_unstemmed | Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis |
| title_short | Enhanced recovery after liver surgery in cirrhotic patients: a systematic review and meta-analysis |
| title_sort | enhanced recovery after liver surgery in cirrhotic patients a systematic review and meta analysis |
| topic | Hepatectomy Perioperative care ERAS Hepatic resection Fibrosis |
| url | https://doi.org/10.1186/s13741-024-00375-x |
| work_keys_str_mv | AT constantdelabays enhancedrecoveryafterliversurgeryincirrhoticpatientsasystematicreviewandmetaanalysis AT nicolasdemartines enhancedrecoveryafterliversurgeryincirrhoticpatientsasystematicreviewandmetaanalysis AT gaetanromainjoliat enhancedrecoveryafterliversurgeryincirrhoticpatientsasystematicreviewandmetaanalysis AT emmanuelmelloul enhancedrecoveryafterliversurgeryincirrhoticpatientsasystematicreviewandmetaanalysis |