Application of the concept of enhanced recovery after surgery in the perioperative period of hepatectomy for hepatocellular carcinoma

Objective To investigate the application value of the concept of enhanced recovery after surgery (ERAS) in the perioperative period of hepatectomy for hepatocellular carcinoma (HCC). Methods Clinical data of 393 patients with HCC who underwent hepatectomy in Anhui Provincial Hospital between January 2010 and May 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different processing methods during perioperative period, the patients were divided into the ERAS group (n=128) and control group (n=265). In the ERAS group, 108 cases were males and 20 females, aged (53±11) years old on average, and the patients received the treatment with the concept of ERAS in the perioperative period. In the control group, 226 cases were males and 39 females, aged (54±11) years old on average, and the patients received the traditional treatment in the perioperative period. Postoperative conditions were observed in two groups. The data including postoperative length of hospital stay and hospitalization expense between two groups were compared using t test. The rate was compared using Pearson Chi-square test, continuous correction Chi-square test or Fisher's exact probability test. Results The percentage of early postoperative off-bed activity and pain numerical rating scale (NRS) score≤3 at postoperative 48 h in the ERAS group was respectively 47.7% and 74.2%, significantly higher than 9.8% and 32.8% in the control group (χ2=71.717, 59.464; P<0.05). The intestinal exhaust time in the ERAS group was (39±16) d, significant earlier than (47±17) d in the control group (t=-3.306, P<0.05). The postoperative length of hospital stay and hospitalization expense in the ERAS group was respectively (7.8±2.5) d and (2.7±0.8) ×104 yuan, significantly less than (8.7±4.2) d and (2.9±1.0)×104 yuan in the control group (t=-2.677, -2.090; P<0.05). Conclusions It is safe and efficacious to use the concept of ERAS in the perioperative period of hepatectomy for HCC. It can accelerate the postoperative recovery of the patients, shorten the length of hospital stay and reduce hospitalization expense without increasing the mortality and readmission rate. Key words: Carcinoma, hepatocellular; Hepatectomy; Perioperative care; Enhanced recovery after surgery