Enhanced recovery after surgery is feasible and safe in liver transplantation: a cohort study

Jens G Hillingsø; Andreas A Rostved; Kristine E Dengsø; Carina L Sørensen; Hans J Frederiksen; Paul S Krohn; Christian R Petersen; Peter N Larsen; Daisuke Fukumori; Stefan K Burgdorff; Henrik Kehlet; Nicolai A Schultz

doi:10.1016/j.hpb.2022.07.010

Enhanced recovery after surgery is feasible and safe in liver transplantation: a cohort study

Jens G Hillingsø^*, Andreas A Rostved, Kristine E Dengsø, Carina L Sørensen, Hans J Frederiksen, Paul S Krohn, Christian R Petersen, Peter N Larsen, Daisuke Fukumori, Stefan K Burgdorff, Henrik Kehlet, Nicolai A Schultz

^*Corresponding author for this work

Abstract

BACKGROUND: 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).

METHODS: 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.

RESULTS: 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.

CONCLUSION: ERAS principles are safe and recommended in patients undergoing OLT resulting in reduced severity of complications and LOS without affecting re-admissions or mortality.

Original language	English
Journal	HPB : the official journal of the International Hepato Pancreato Biliary Association
Volume	24
Issue number	11
Pages (from-to)	2022-2028
Number of pages	7
ISSN	1365-182X
DOIs	https://doi.org/10.1016/j.hpb.2022.07.010
Publication status	Published - 2022

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Hillingsø, J. G., Rostved, A. A., Dengsø, K. E., Sørensen, C. L., Frederiksen, H. J., Krohn, P. S., Petersen, C. R., Larsen, P. N., Fukumori, D., Burgdorff, S. K., Kehlet, H., & Schultz, N. A. (2022). Enhanced recovery after surgery is feasible and safe in liver transplantation: a cohort study. HPB : the official journal of the International Hepato Pancreato Biliary Association, 24(11), 2022-2028. https://doi.org/10.1016/j.hpb.2022.07.010

Enhanced recovery after surgery is feasible and safe in liver transplantation: a cohort study. / Hillingsø, Jens G ; Rostved, Andreas A ; Dengsø, Kristine E et al.
In: HPB : the official journal of the International Hepato Pancreato Biliary Association, Vol. 24, No. 11, 2022, p. 2022-2028.

Research output: Contribution to journal › Journal article › Research › peer-review

Hillingsø, JG , Rostved, AA , Dengsø, KE, Sørensen, CL, Frederiksen, HJ , Krohn, PS, Petersen, CR, Larsen, PN , Fukumori, D , Burgdorff, SK , Kehlet, H & Schultz, NA 2022, 'Enhanced recovery after surgery is feasible and safe in liver transplantation: a cohort study', HPB : the official journal of the International Hepato Pancreato Biliary Association, vol. 24, no. 11, pp. 2022-2028. https://doi.org/10.1016/j.hpb.2022.07.010

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title = "Enhanced recovery after surgery is feasible and safe in liver transplantation: a cohort study",

abstract = "BACKGROUND: 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).METHODS: 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{\textregistered}) and re-admissions.RESULTS: 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.CONCLUSION: ERAS principles are safe and recommended in patients undergoing OLT resulting in reduced severity of complications and LOS without affecting re-admissions or mortality.",

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doi = "10.1016/j.hpb.2022.07.010",

language = "English",

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T1 - Enhanced recovery after surgery is feasible and safe in liver transplantation

T2 - a cohort study

AU - Hillingsø, Jens G

AU - Rostved, Andreas A

AU - Dengsø, Kristine E

AU - Sørensen, Carina L

AU - Frederiksen, Hans J

AU - Krohn, Paul S

AU - Petersen, Christian R

AU - Larsen, Peter N

AU - Fukumori, Daisuke

AU - Burgdorff, Stefan K

AU - Kehlet, Henrik

AU - Schultz, Nicolai A

PY - 2022

Y1 - 2022

N2 - BACKGROUND: 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).METHODS: 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.RESULTS: 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.CONCLUSION: ERAS principles are safe and recommended in patients undergoing OLT resulting in reduced severity of complications and LOS without affecting re-admissions or mortality.

AB - BACKGROUND: 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).METHODS: 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.RESULTS: 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.CONCLUSION: ERAS principles are safe and recommended in patients undergoing OLT resulting in reduced severity of complications and LOS without affecting re-admissions or mortality.

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SN - 1365-182X

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Enhanced recovery after surgery is feasible and safe in liver transplantation: a cohort study

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