Evaluation of a fast-track programme for patients undergoing liver resection

Background: Recent developments in perioperative pathophysiology and care have documented evidence‐based, multimodal rehabilitation (fast‐track) to hasten recovery and to decrease morbidity and hospital stay for several major surgical procedures. The aim of this study was to investigate the effect of introducing fast‐track principles for perioperative care in unselected patients undergoing open or laparoscopic liver resection. Methods: This was a prospective study involving the first 100 consecutive patients who followed fast‐track principles for liver resection. Catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid‐sparing multimodal pain treatment was given for the first week. Discharge criteria were: pain sufficiently controlled by oral analgesics alone, patient comfortable with discharge and no untreated complications. Results: Median length of stay (LOS) for all patients was 5 days, with 2 days after laparoscopic versus 5 days following open resection (P < 0·001). Median LOS after minor open resections (fewer than 3 segments) was 5 days versus 6 days for major resections (3 or more segments) (P < 0·001). Simple right or left hemihepatectomies had a median LOS of 5 days. The readmission rate was 6·0 per cent and 30‐day mortality was zero. Conclusion: Fast‐track principles for perioperative care were introduced successfully and are safe after liver resection. Routine discharge 2 days after laparoscopic resection and 4–5 days after open liver resection may be feasible. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Fast‐track recovery after liver surgery is safe