Department of Surgery and Transplantation, Centre of Cancer and Organ Dysfunction, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark.
Department of Surgery and Transplantation, Centre of Cancer and Organ Dysfunction, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark.
HPB (Oxford). 2022 Nov;24(11):2022-2028. doi: 10.1016/j.hpb.2022.07.010. Epub 2022 Jul 20.
The principles of enhanced recovery after surgery (ERAS) are being applied to still more advanced procedures. Liver transplantation offers a unique opportunity for a multimodal approach including donor care as well. Our objective was to determine if ERAS was applicable and safe in orthotopic liver transplantation (OLT).
A national single centre retrospective study showing the implementation of ERAS from 2013 to 2019 with the proceeding 2 years serving as baseline. The primary endpoints were mortality, length of stay (LOS) in the ward and intensive care unit stay. Secondary endpoints were complications estimated by Dindo-Clavien classification, comprehensive complication index (CCI®) and re-admissions.
A total of 334 patients were included. LOS was significantly reduced from a median of 22.5 days at introduction to 14 days at 2019. Cold ischaemia time was reduced from a mean of 10.7 to 6.0 h and the use of blood products (erythrocytes, plasma and thrombocytes) from a median of 28 to 6 units. Complications were reduced in severity. Mortality and readmission rates were not affected.
ERAS principles are safe and recommended in patients undergoing OLT resulting in reduced severity of complications and LOS without affecting re-admissions or mortality.
手术后加速康复（ERAS）原则正被应用于更先进的手术中。肝移植为包括供者管理在内的多模式方法提供了独特的机会。我们的目的是确定 ERAS 在原位肝移植（OLT）中是否适用和安全。
一项全国性单中心回顾性研究，展示了 2013 年至 2019 年 ERAS 的实施情况，前 2 年作为基线。主要终点是死亡率、病房和重症监护病房的住院时间。次要终点是通过 Dindo-Clavien 分类、综合并发症指数（CCI®）和再入院来评估并发症。
共纳入 334 例患者。引入 ERAS 后，住院时间从中位数 22.5 天显著缩短至 2019 年的 14 天。冷缺血时间从平均 10.7 小时缩短至 6.0 小时，血液制品（红细胞、血浆和血小板）的使用从中位数 28 单位减少至 6 单位。并发症的严重程度降低。死亡率和再入院率不受影响。
ERAS 原则在接受 OLT 的患者中是安全和推荐的，可降低并发症的严重程度和住院时间，而不会影响再入院或死亡率。
