Johanna Savikko1, Leena Vikatmaa2, Anna-Maria Hiltunen3,4, Noora Mallat2, Eija Tukiainen5, Sari-Mari Salonen5, Arno Nordin5. 1. Department of Transplantation and Liver Surgery, HUS Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland. johanna.savikko@helsinki.fi. 2. Department of Anesthesiology and Intensive Care Medicine, HUS Helsinki University Hospital, Helsinki, Finland. 3. Department of Industrial Engineering and Management, HEMA Institute, Aalto University, Helsinki, Finland. 4. Nordic Healthcare Group, Helsinki, Finland. 5. Department of Transplantation and Liver Surgery, HUS Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland.
Abstract
INTRODUCTION: Enhanced recovery protocols (ERP) accelerate recovery and shorten postoperative hospital stay. This increased knowledge of ERPs has also gradually implemented into liver surgery. However, in laparoscopic liver surgery (LLS), the experience of optimized perioperative care protocols is still limited. METHODS: We prospectively studied the implementation of multimodal ERP principles to LLS in the first 100 consecutive patients. Opioid-sparing multimodal pain management was applied together with early mobilization already in the postoperative care unit (PACU). Drains and catheters were avoided and per oral intake was initiated promptly. Primary pain control was achieved with iv NSAIDS, low-dose opioid and corticosteroids. Combination of per oral ibuprofen and long-acting tramadol was routinely administered shortly after operation. The multiprofessional adherence to the protocol was also evaluated. RESULTS: Investigated LLS was performed during Aug 2016-Apr 2019. Operations were done due to malignancy in 83 (83%) of cases, mostly for colorectal liver metastases (n = 52, 52%). Forty-eight (48%) of the operated patients were female. Median age was 65 years (range 17-91). The American Society of Anaesthesiologists Physical Status (ASA) classification median was three. Median postoperative hospital stay was 2 days (range 1-8 days). More than seventy percent of patients were discharged by the second postoperative day and nearly ninety percent by the third postoperative day. Complications after surgery were few. The new ERP elements were adopted in most of the cases. CONCLUSIONS: ERP was introduced safely and effectively after LLS. The adherence to the ERP was good. Routine discharge 1-2 days after LLS is realistic and achievable.
INTRODUCTION: Enhanced recovery protocols (ERP) accelerate recovery and shorten postoperative hospital stay. This increased knowledge of ERPs has also gradually implemented into liver surgery. However, in laparoscopic liver surgery (LLS), the experience of optimized perioperative care protocols is still limited. METHODS: We prospectively studied the implementation of multimodal ERP principles to LLS in the first 100 consecutive patients. Opioid-sparing multimodal pain management was applied together with early mobilization already in the postoperative care unit (PACU). Drains and catheters were avoided and per oral intake was initiated promptly. Primary pain control was achieved with iv NSAIDS, low-dose opioid and corticosteroids. Combination of per oral ibuprofen and long-acting tramadol was routinely administered shortly after operation. The multiprofessional adherence to the protocol was also evaluated. RESULTS: Investigated LLS was performed during Aug 2016-Apr 2019. Operations were done due to malignancy in 83 (83%) of cases, mostly for colorectal liver metastases (n = 52, 52%). Forty-eight (48%) of the operated patients were female. Median age was 65 years (range 17-91). The American Society of Anaesthesiologists Physical Status (ASA) classification median was three. Median postoperative hospital stay was 2 days (range 1-8 days). More than seventy percent of patients were discharged by the second postoperative day and nearly ninety percent by the third postoperative day. Complications after surgery were few. The new ERP elements were adopted in most of the cases. CONCLUSIONS: ERP was introduced safely and effectively after LLS. The adherence to the ERP was good. Routine discharge 1-2 days after LLS is realistic and achievable.
Authors: Mohammad Abu Hilal; Luca Aldrighetti; Ibrahim Dagher; Bjorn Edwin; Roberto Ivan Troisi; Ruslan Alikhanov; Somaiah Aroori; Giulio Belli; Marc Besselink; Javier Briceno; Brice Gayet; Mathieu D'Hondt; Mickael Lesurtel; Krishna Menon; Peter Lodge; Fernando Rotellar; Julio Santoyo; Olivier Scatton; Olivier Soubrane; Robert Sutcliffe; Ronald Van Dam; Steve White; Mark Christopher Halls; Federica Cipriani; Marcel Van der Poel; Ruben Ciria; Leonid Barkhatov; Yrene Gomez-Luque; Sira Ocana-Garcia; Andrew Cook; Joseph Buell; Pierre-Alain Clavien; Christos Dervenis; Giuseppe Fusai; David Geller; Hauke Lang; John Primrose; Mark Taylor; Thomas Van Gulik; Go Wakabayashi; Horacio Asbun; Daniel Cherqui Journal: Ann Surg Date: 2018-07 Impact factor: 12.969