Second Generation of a Fast-track Liver Resection Programme

Nicolai A Schultz; Peter N Larsen; B Klarskov; L M Plum; Hans-Jørgen Frederiksen; Henrik Kehlet; Jens G Hillingsø

doi:10.1007/s00268-017-4399-3

Second Generation of a Fast-track Liver Resection Programme

Nicolai A Schultz, Peter N Larsen, B Klarskov, L M Plum, Hans-Jørgen Frederiksen, Henrik Kehlet, Jens G Hillingsø

Department of Clinical Medicine

5 Citations (Scopus)

Abstract

BACKGROUND: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over time of a modified previously published fast-track programme in unselected patients undergoing open or laparoscopic liver resection.

METHODS: A prospective study includes the first 121 consecutive patients following an updated fast-track programme for liver resection. High-dose methylprednisolone was given to all patients before surgery, catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. The discharge criteria were (1) pain sufficiently controlled by oral analgesics only; (2) patient comfortable with discharge; (3) no untreated complications.

RESULTS: The median length of stay (LOS) for all patients was 4 days, with 2 days after laparoscopic vs. 4 days for open resections. The median LOS after major hepatectomies (≥3 segments) was 5 days. The readmission rate was 6% and the 30-day mortality zero. The LOS decreased compared to our first-generation fast-track programme with LOS 5 days.

CONCLUSIONS: Fast-track principles for perioperative care and early discharge are safe even after major liver resection. The introduction of high-dose steroids preoperatively might have facilitated a shorter LOS. Routine discharge on POD 1 or 2 after laparoscopic resection and on POD 4 after open liver resection has proven to be feasible.

Original language	English
Journal	World Journal of Surgery
Volume	42
Issue number	6
Pages (from-to)	1860-1866
ISSN	0364-2313
DOIs	https://doi.org/10.1007/s00268-017-4399-3
Publication status	Published - 1 Jun 2018

Keywords

Adult
Aged
Aged, 80 and over
Female
Hepatectomy/methods
Humans
Laparoscopy
Length of Stay
Male
Middle Aged
Perioperative Care
Prospective Studies

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10.1007/s00268-017-4399-3

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title = "Second Generation of a Fast-track Liver Resection Programme",

abstract = "BACKGROUND: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over time of a modified previously published fast-track programme in unselected patients undergoing open or laparoscopic liver resection.METHODS: A prospective study includes the first 121 consecutive patients following an updated fast-track programme for liver resection. High-dose methylprednisolone was given to all patients before surgery, catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. The discharge criteria were (1) pain sufficiently controlled by oral analgesics only; (2) patient comfortable with discharge; (3) no untreated complications.RESULTS: The median length of stay (LOS) for all patients was 4 days, with 2 days after laparoscopic vs. 4 days for open resections. The median LOS after major hepatectomies (≥3 segments) was 5 days. The readmission rate was 6% and the 30-day mortality zero. The LOS decreased compared to our first-generation fast-track programme with LOS 5 days.CONCLUSIONS: Fast-track principles for perioperative care and early discharge are safe even after major liver resection. The introduction of high-dose steroids preoperatively might have facilitated a shorter LOS. Routine discharge on POD 1 or 2 after laparoscopic resection and on POD 4 after open liver resection has proven to be feasible.",

keywords = "Adult, Aged, Aged, 80 and over, Female, Hepatectomy/methods, Humans, Laparoscopy, Length of Stay, Male, Middle Aged, Perioperative Care, Prospective Studies",

author = "Schultz, {Nicolai A} and Larsen, {Peter N} and B Klarskov and Plum, {L M} and Hans-J{\o}rgen Frederiksen and Henrik Kehlet and Hillings{\o}, {Jens G}",

year = "2018",

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doi = "10.1007/s00268-017-4399-3",

language = "English",

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pages = "1860--1866",

journal = "World Journal of Surgery",

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T1 - Second Generation of a Fast-track Liver Resection Programme

AU - Schultz, Nicolai A

AU - Larsen, Peter N

AU - Klarskov, B

AU - Plum, L M

AU - Frederiksen, Hans-Jørgen

AU - Kehlet, Henrik

AU - Hillingsø, Jens G

PY - 2018/6/1

Y1 - 2018/6/1

N2 - BACKGROUND: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over time of a modified previously published fast-track programme in unselected patients undergoing open or laparoscopic liver resection.METHODS: A prospective study includes the first 121 consecutive patients following an updated fast-track programme for liver resection. High-dose methylprednisolone was given to all patients before surgery, catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. The discharge criteria were (1) pain sufficiently controlled by oral analgesics only; (2) patient comfortable with discharge; (3) no untreated complications.RESULTS: The median length of stay (LOS) for all patients was 4 days, with 2 days after laparoscopic vs. 4 days for open resections. The median LOS after major hepatectomies (≥3 segments) was 5 days. The readmission rate was 6% and the 30-day mortality zero. The LOS decreased compared to our first-generation fast-track programme with LOS 5 days.CONCLUSIONS: Fast-track principles for perioperative care and early discharge are safe even after major liver resection. The introduction of high-dose steroids preoperatively might have facilitated a shorter LOS. Routine discharge on POD 1 or 2 after laparoscopic resection and on POD 4 after open liver resection has proven to be feasible.

AB - BACKGROUND: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over time of a modified previously published fast-track programme in unselected patients undergoing open or laparoscopic liver resection.METHODS: A prospective study includes the first 121 consecutive patients following an updated fast-track programme for liver resection. High-dose methylprednisolone was given to all patients before surgery, catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. The discharge criteria were (1) pain sufficiently controlled by oral analgesics only; (2) patient comfortable with discharge; (3) no untreated complications.RESULTS: The median length of stay (LOS) for all patients was 4 days, with 2 days after laparoscopic vs. 4 days for open resections. The median LOS after major hepatectomies (≥3 segments) was 5 days. The readmission rate was 6% and the 30-day mortality zero. The LOS decreased compared to our first-generation fast-track programme with LOS 5 days.CONCLUSIONS: Fast-track principles for perioperative care and early discharge are safe even after major liver resection. The introduction of high-dose steroids preoperatively might have facilitated a shorter LOS. Routine discharge on POD 1 or 2 after laparoscopic resection and on POD 4 after open liver resection has proven to be feasible.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Hepatectomy/methods

KW - Humans

KW - Laparoscopy

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Perioperative Care

KW - Prospective Studies

U2 - 10.1007/s00268-017-4399-3

DO - 10.1007/s00268-017-4399-3

M3 - Journal article

C2 - 29302723

SN - 0364-2313

VL - 42

SP - 1860

EP - 1866

JO - World Journal of Surgery

JF - World Journal of Surgery

IS - 6

ER -

Second Generation of a Fast-track Liver Resection Programme

Abstract

Keywords

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