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 o...
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| Veröffentlicht in: | British journal of surgery 2013-01, Vol.100 (1), p.138-143 |
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| container_title | British journal of surgery |
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| creator | Schultz, N. A. Larsen, P. N. Klarskov, B. Plum, L. M. Frederiksen, H. J. Christensen, B. M. Kehlet, H. Hillingsø, J. G. |
| description | 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 |
| doi_str_mv | 10.1002/bjs.8996 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1223430012</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2831804531</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4186-4e368de32f898912a7d51dcfd601787a9ffe83db6fe66f4a359daf982d9e92ca3</originalsourceid><addsrcrecordid>eNpd0VtrFTEQB_Agij1WwU8gARF82TaXTTZ5tKWtyqFSWqn4EuZsJoc93csx2e3l25ulxxZ8mof5MczMn5D3nB1wxsThapMOjLX6BVlwqVUhuDYvyYIxVhVcCrlH3qS0YYxLpsRrsick16o05YIsT26hnWBshp4OgQINkMZijFDf0G0c1hG6DmkYIt1mhP2Y6NR7jOuh6de0bW4x0ogJ63nCW_IqQJvw3a7uk5-nJ1fHX4vlj7Nvx1-WRV1yo4sSpTYepQjGGssFVF5xXwevGa9MBTYENNKvdECtQwlSWQ_BGuEtWlGD3CefH-fmDf9MmEbXNanGtoUehyk5LoQsZT5XZPrxP7oZptjn7WbFK6uM1Vl92Klp1aF329h0EB_cvz9l8GkHINXQhgh93aRnpyullFDZFY_urmnx4anPmZtzcjknN-fkjr5fzvXZN2nE-ycP8cbpSlbKXZ-fueuL04vfRi3dL_kX1pSTEw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1221795896</pqid></control><display><type>article</type><title>Evaluation of a fast-track programme for patients undergoing liver resection</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Schultz, N. A. ; Larsen, P. N. ; Klarskov, B. ; Plum, L. M. ; Frederiksen, H. J. ; Christensen, B. M. ; Kehlet, H. ; Hillingsø, J. G.</creator><creatorcontrib>Schultz, N. A. ; Larsen, P. N. ; Klarskov, B. ; Plum, L. M. ; Frederiksen, H. J. ; Christensen, B. M. ; Kehlet, H. ; Hillingsø, J. G.</creatorcontrib><description>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</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.8996</identifier><identifier>PMID: 23165484</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Carcinoma, Hepatocellular - secondary ; Carcinoma, Hepatocellular - surgery ; Female ; General aspects ; Hepatectomy - adverse effects ; Hepatectomy - methods ; Hepatectomy - rehabilitation ; Hepatectomy - statistics & numerical data ; Humans ; Laparoscopy - rehabilitation ; Length of Stay ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Liver, biliary tract, pancreas, portal circulation, spleen ; Male ; Medical sciences ; Middle Aged ; Pain - etiology ; Perioperative Care - methods ; Perioperative Care - statistics & numerical data ; Program Evaluation ; Prospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Young Adult</subject><ispartof>British journal of surgery, 2013-01, Vol.100 (1), p.138-143</ispartof><rights>Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.</rights><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4186-4e368de32f898912a7d51dcfd601787a9ffe83db6fe66f4a359daf982d9e92ca3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.8996$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.8996$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,4010,27900,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26755525$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23165484$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schultz, N. A.</creatorcontrib><creatorcontrib>Larsen, P. N.</creatorcontrib><creatorcontrib>Klarskov, B.</creatorcontrib><creatorcontrib>Plum, L. M.</creatorcontrib><creatorcontrib>Frederiksen, H. J.</creatorcontrib><creatorcontrib>Christensen, B. M.</creatorcontrib><creatorcontrib>Kehlet, H.</creatorcontrib><creatorcontrib>Hillingsø, J. G.</creatorcontrib><title>Evaluation of a fast-track programme for patients undergoing liver resection</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>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</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Hepatocellular - secondary</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>Female</subject><subject>General aspects</subject><subject>Hepatectomy - adverse effects</subject><subject>Hepatectomy - methods</subject><subject>Hepatectomy - rehabilitation</subject><subject>Hepatectomy - statistics & numerical data</subject><subject>Humans</subject><subject>Laparoscopy - rehabilitation</subject><subject>Length of Stay</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pain - etiology</subject><subject>Perioperative Care - methods</subject><subject>Perioperative Care - statistics & numerical data</subject><subject>Program Evaluation</subject><subject>Prospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Young Adult</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0VtrFTEQB_Agij1WwU8gARF82TaXTTZ5tKWtyqFSWqn4EuZsJoc93csx2e3l25ulxxZ8mof5MczMn5D3nB1wxsThapMOjLX6BVlwqVUhuDYvyYIxVhVcCrlH3qS0YYxLpsRrsick16o05YIsT26hnWBshp4OgQINkMZijFDf0G0c1hG6DmkYIt1mhP2Y6NR7jOuh6de0bW4x0ogJ63nCW_IqQJvw3a7uk5-nJ1fHX4vlj7Nvx1-WRV1yo4sSpTYepQjGGssFVF5xXwevGa9MBTYENNKvdECtQwlSWQ_BGuEtWlGD3CefH-fmDf9MmEbXNanGtoUehyk5LoQsZT5XZPrxP7oZptjn7WbFK6uM1Vl92Klp1aF329h0EB_cvz9l8GkHINXQhgh93aRnpyullFDZFY_urmnx4anPmZtzcjknN-fkjr5fzvXZN2nE-ycP8cbpSlbKXZ-fueuL04vfRi3dL_kX1pSTEw</recordid><startdate>201301</startdate><enddate>201301</enddate><creator>Schultz, N. A.</creator><creator>Larsen, P. N.</creator><creator>Klarskov, B.</creator><creator>Plum, L. M.</creator><creator>Frederiksen, H. J.</creator><creator>Christensen, B. M.</creator><creator>Kehlet, H.</creator><creator>Hillingsø, J. G.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201301</creationdate><title>Evaluation of a fast-track programme for patients undergoing liver resection</title><author>Schultz, N. A. ; Larsen, P. N. ; Klarskov, B. ; Plum, L. M. ; Frederiksen, H. J. ; Christensen, B. M. ; Kehlet, H. ; Hillingsø, J. G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4186-4e368de32f898912a7d51dcfd601787a9ffe83db6fe66f4a359daf982d9e92ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Hepatocellular - secondary</topic><topic>Carcinoma, Hepatocellular - surgery</topic><topic>Female</topic><topic>General aspects</topic><topic>Hepatectomy - adverse effects</topic><topic>Hepatectomy - methods</topic><topic>Hepatectomy - rehabilitation</topic><topic>Hepatectomy - statistics & numerical data</topic><topic>Humans</topic><topic>Laparoscopy - rehabilitation</topic><topic>Length of Stay</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pain - etiology</topic><topic>Perioperative Care - methods</topic><topic>Perioperative Care - statistics & numerical data</topic><topic>Program Evaluation</topic><topic>Prospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schultz, N. A.</creatorcontrib><creatorcontrib>Larsen, P. N.</creatorcontrib><creatorcontrib>Klarskov, B.</creatorcontrib><creatorcontrib>Plum, L. M.</creatorcontrib><creatorcontrib>Frederiksen, H. J.</creatorcontrib><creatorcontrib>Christensen, B. M.</creatorcontrib><creatorcontrib>Kehlet, H.</creatorcontrib><creatorcontrib>Hillingsø, J. G.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schultz, N. A.</au><au>Larsen, P. N.</au><au>Klarskov, B.</au><au>Plum, L. M.</au><au>Frederiksen, H. J.</au><au>Christensen, B. M.</au><au>Kehlet, H.</au><au>Hillingsø, J. G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of a fast-track programme for patients undergoing liver resection</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2013-01</date><risdate>2013</risdate><volume>100</volume><issue>1</issue><spage>138</spage><epage>143</epage><pages>138-143</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>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</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>23165484</pmid><doi>10.1002/bjs.8996</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Carcinoma, Hepatocellular - secondary Carcinoma, Hepatocellular - surgery Female General aspects Hepatectomy - adverse effects Hepatectomy - methods Hepatectomy - rehabilitation Hepatectomy - statistics & numerical data Humans Laparoscopy - rehabilitation Length of Stay Liver Neoplasms - secondary Liver Neoplasms - surgery Liver, biliary tract, pancreas, portal circulation, spleen Male Medical sciences Middle Aged Pain - etiology Perioperative Care - methods Perioperative Care - statistics & numerical data Program Evaluation Prospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Young Adult |
| title | Evaluation of a fast-track programme for patients undergoing liver resection |
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