The Effect of introducing a nurse guided enhanced recovery after surgery program on patients undergoing hepatectomy

Abstract

Background: enhanced recovery after surgery (ERAS) could shorten hospital stay and decrease postoperative complications for patients undergoing colorectal surgery. Whether  ERAS have  the  same   effect   in   patients undergoing hepatectomy is not clear, researches led by nurse are especially   rare.   The   study   aimed   at investigating the safety, feasibility and efficiency of nurse  guided  ERAS program on patients undergoing hepatectomy

Method: patients undergoing liver  resection treated  with nurse guided ERAS program were taken for ERAS group. ERAS program included: perioperative  respiratory  function training, perioperative diet guidance, early postoperative activity and  postoperative  pain  management. Primary outcome measures we postoperative length of stay and postoperative complications. Secondary outcome measures were the first time to flatus and defecation, NRS on first and second postoperative day (POD), mortality and readmission rate.

Result: The study included totally 100 patients, the patients in each group were 50.The length of stay of patients in ERAS group was shorter than control group (5 days vs 7 days, P=0.001). The overall complications rate and general complications rate of patients in ERAS group were obviously lower than control group (12% vs 30%, P=0.027; 8% vs 24%, P=0.029). The first time to flatus and defecation of ERAS group were both earlier than control group (3 days vs 4 days, P=0.000; 5 days vs 6 days, P=0.010). The NRS score on POD 1 and POD 2 of the ERAS groups were both lower than control group (6 vs 4, P=0.006; 5 vs 3, P=0.000). The surgery-related complications rate of two groups had no significant difference. There were no perioperative mortality or readmission of two groups in the study (0, P=1.000).

Conclusion: The application of nurse guided ERAS program safe, effective and feasible for patients undergoing liver resection. It shortened postoperative length of stay  and decreased postoperative complication. At the same time, it reduced postoperative pain and improved patient comfort.