Ciulli Cristina, Fogliati Alessandro, Scacchi Andrea, Scotti Mauro Alessandro, Aprigliano Michele, Braga Marco, Romano Fabrizio, Garancini Mattia
HPB Surgery Unit, Department of General Surgery, IRCCS San Gerardo dei Tintori Foundation, Via Pergolesi 33, 20900, Monza, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy.
Updates Surg. 2025 Mar 14. doi: 10.1007/s13304-025-02148-7.
Enhanced Recovery Protocol (ERP) has the purpose of minimising postoperative hospitalisation and expediting the restoration of preoperative patient conditions. This study seeks to investigate the correlation between early non-compliance to postoperative items within ERP and complications in liver surgery.
From January 2019 to December 2022 the ERP was proposed to all consecutive patients undergoing liver surgery. Nasogastric tube removal, resuming oral intake and mobilisation and obtaining an adequate glycaemic control were the postoperative items considered as non-compliance indicators. Data were prospectively collected and analysed.
192 patients were included, comprising 99(51.6%) hepatocellular carcinoma, 58(30.2%) colorectal metastasis and 24(12.5%) benign/other pathology. A minimally invasive approach was adopted in 57.3% of cases. Postoperative morbidities occurred in 44.8% of patients, while major complications in 13% of patients. Cirrhosis (p < 0.001), minimally invasive approach (p < 0.004), early oral intake (p < 0.019) and early mobilisation (p < 0.019) significantly correlated to morbidity at multivariate analysis. The complication rate escalated from 26.9% in fully compliant patients, to 58% in patients with two non-compliance indicators and to 91.2% in fully non-compliant patients (p < 0.001). The same trend was confirmed for major complications (p < 0.001).
Early non-compliance to ERP postoperative items in liver surgery was significantly associated with overall and major morbidity.
加速康复方案（ERP）旨在尽量减少术后住院时间，并加快患者术前状况的恢复。本研究旨在探讨肝手术中早期不遵守ERP术后项目与并发症之间的相关性。
从2019年1月至2022年12月，对所有接受肝手术的连续患者实施ERP。鼻胃管拔除、恢复经口进食和活动以及实现血糖充分控制被视为不遵守的术后项目指标。前瞻性收集并分析数据。
纳入192例患者，其中肝细胞癌99例（51.6%），结直肠癌转移58例（30.2%），良性/其他病理类型24例（12.5%）。57.3%的病例采用了微创方法。44.8%的患者发生术后并发症，13%的患者发生严重并发症。多因素分析显示，肝硬化（p<0.001）、微创方法（p<0.004）、早期经口进食（p<0.019）和早期活动（p<0.019）与并发症显著相关。完全遵守的患者并发症发生率为26.9%，有两项不遵守指标的患者为58%，完全不遵守的患者为91.2%（p<0.001）。严重并发症也呈现相同趋势（p<0.001）。
肝手术中早期不遵守ERP术后项目与总体及严重并发症显著相关。
