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Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial

PURPOSE: Enhanced recovery after surgery (ERAS) is beneficial to patients undergoing digestive surgery. However, its efficacy in patients undergoing open hepatectomy remains unclear. METHODS: Consecutive patients scheduled for open hepatectomy were randomly assigned to undergo either ERAS or convent...

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Autores principales: Nakanishi, Wataru, Miyagi, Shigehito, Tokodai, Kazuaki, Fujio, Atsushi, Sasaki, Kengo, Shono, Yoshihiro, Unno, Michiaki, Kamei, Takashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Surgical Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704272/
https://www.ncbi.nlm.nih.gov/pubmed/33304859
http://dx.doi.org/10.4174/astr.2020.99.6.320
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author Nakanishi, Wataru
Miyagi, Shigehito
Tokodai, Kazuaki
Fujio, Atsushi
Sasaki, Kengo
Shono, Yoshihiro
Unno, Michiaki
Kamei, Takashi
author_facet Nakanishi, Wataru
Miyagi, Shigehito
Tokodai, Kazuaki
Fujio, Atsushi
Sasaki, Kengo
Shono, Yoshihiro
Unno, Michiaki
Kamei, Takashi
author_sort Nakanishi, Wataru
collection PubMed
description PURPOSE: Enhanced recovery after surgery (ERAS) is beneficial to patients undergoing digestive surgery. However, its efficacy in patients undergoing open hepatectomy remains unclear. METHODS: Consecutive patients scheduled for open hepatectomy were randomly assigned to undergo either ERAS or conventional postoperative management. The primary endpoint was the amount of time that elapsed before patients were considered medically fit for discharge (MFD) and length of hospital stay (LOHS). Secondary endpoints included morbidity, mortality, the time to first flatus, defecation, first walk, and freedom from infusion. Perioperative serum nutritional markers, insulin resistance, respiratory quotient (RQ), and resting energy expenditure (REE) were also assessed. RESULTS: Between August 2014 and March 2017, 57 patients were randomized into 2 groups; ERAS group (n = 29) and conventional management (n = 28). The median MFD was not significantly different between the ERAS and conventional management groups (6.5 vs. 7 days; P = 0.381). Recovery from gastrointestinal paresis was significantly quicker in the ERAS group (1.8 vs. 2.4 days; P = 0.004). There were no significant differences in serum markers, insulin resistance, RQ, and REE. CONCLUSION: This trial did not demonstrate greater efficacy of the ERAS protocol following open hepatectomy in terms of the MFD and LOHS. However, the ERAS protocol was associated with better recovery from postoperative gastrointestinal paresis, suggesting that it is useful for patients undergoing open hepatectomy.
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spelling pubmed-77042722020-12-09 Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial Nakanishi, Wataru Miyagi, Shigehito Tokodai, Kazuaki Fujio, Atsushi Sasaki, Kengo Shono, Yoshihiro Unno, Michiaki Kamei, Takashi Ann Surg Treat Res Original Article PURPOSE: Enhanced recovery after surgery (ERAS) is beneficial to patients undergoing digestive surgery. However, its efficacy in patients undergoing open hepatectomy remains unclear. METHODS: Consecutive patients scheduled for open hepatectomy were randomly assigned to undergo either ERAS or conventional postoperative management. The primary endpoint was the amount of time that elapsed before patients were considered medically fit for discharge (MFD) and length of hospital stay (LOHS). Secondary endpoints included morbidity, mortality, the time to first flatus, defecation, first walk, and freedom from infusion. Perioperative serum nutritional markers, insulin resistance, respiratory quotient (RQ), and resting energy expenditure (REE) were also assessed. RESULTS: Between August 2014 and March 2017, 57 patients were randomized into 2 groups; ERAS group (n = 29) and conventional management (n = 28). The median MFD was not significantly different between the ERAS and conventional management groups (6.5 vs. 7 days; P = 0.381). Recovery from gastrointestinal paresis was significantly quicker in the ERAS group (1.8 vs. 2.4 days; P = 0.004). There were no significant differences in serum markers, insulin resistance, RQ, and REE. CONCLUSION: This trial did not demonstrate greater efficacy of the ERAS protocol following open hepatectomy in terms of the MFD and LOHS. However, the ERAS protocol was associated with better recovery from postoperative gastrointestinal paresis, suggesting that it is useful for patients undergoing open hepatectomy. The Korean Surgical Society 2020-12 2020-11-26 /pmc/articles/PMC7704272/ /pubmed/33304859 http://dx.doi.org/10.4174/astr.2020.99.6.320 Text en Copyright © 2020, the Korean Surgical Society http://creativecommons.org/licenses/by-nc/4.0/ Annals of Surgical Treatment and Research is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Nakanishi, Wataru
Miyagi, Shigehito
Tokodai, Kazuaki
Fujio, Atsushi
Sasaki, Kengo
Shono, Yoshihiro
Unno, Michiaki
Kamei, Takashi
Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial
title Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial
title_full Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial
title_fullStr Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial
title_full_unstemmed Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial
title_short Effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial
title_sort effect of enhanced recovery after surgery protocol on recovery after open hepatectomy: a randomized clinical trial
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704272/
https://www.ncbi.nlm.nih.gov/pubmed/33304859
http://dx.doi.org/10.4174/astr.2020.99.6.320
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