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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Enhanced recovery after surgery in liver transplantation: Challenges and feasibility
Georgios Katsanos, Konstantina-Eleni Karakasi, Nikolaos Antoniadis, Stella Vasileiadou, Athanasios Kofinas, Antonios Morsi-Yeroyannis, Evangelia Michailidou, Ioannis Goulis, Emmanouil Sinakos, Olga Giouleme, Ilias Marios Oikonomou, George Evlavis, Georgios Tsakiris, Eleni Massa, Eleni Mouloudi, Georgios Tsoulfas
Georgios Katsanos, Konstantina-Eleni Karakasi, Nikolaos Antoniadis, Stella Vasileiadou, Athanasios Kofinas, Antonios Morsi-Yeroyannis, Ilias Marios Oikonomou, Georgios Tsakiris, Georgios Tsoulfas, Department of Transplantation, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
Evangelia Michailidou, Eleni Massa, Eleni Mouloudi, Intensive Care Unit, National Health System, Hippokration General Hospital, Thessaloniki 54642, Greece
Ioannis Goulis, Emmanouil Sinakos, Fourth Department of Internal Medicine, Hippokration General Hospital, Medical School of Aristotle University, Thessaloniki 54642, Greece
Olga Giouleme, Second Propaedeutic Department of Internal Medicine, Hippokratio General Hospital, Aristotle University Thessaloniki, Thessaloniki 54642, Greece
George Evlavis, Nursing Department, National Health System, Department of Transplantation, Hippokration General Hospital, Thessaloniki 54642, Greece
Author contributions: Katsanos G, Karakasi KE, and Tsoulfas G wrote the manuscript; Morsi-Yeroyannis A and Sinakos E conducted the statistics; Goulis I, Giouleme O, and Vasileiadou S, reviewed the articles; Oikonomou IM and Mochailidou E proofread the manuscript; Tsoulfas G, Katsanos G, and Mouloudi E designed the review; Antoniadis N, Massa E, Tsakiris G, and Evlavis G conducted the bibliographic research and analyzed the results; All authors read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Georgios Tsoulfas, FACS, FICS, MD, PhD, Associate Professor, Department of Transplantation, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Konstantinoupoleos 49, Thessaloniki 54642, Greece.
tsoulfasg@gmail.com
Received: June 28, 2021
Peer-review started: June 28, 2021
First decision: July 14, 2021
Revised: August 4, 2022
Accepted: June 20, 2022
Article in press: June 20, 2022
Published online: July 18, 2022
Processing time: 381 Days and 5.6 Hours
BACKGROUND
Enhanced recovery after surgery (ERAS) started a revolution that changed age-old surgical stereotypical practices regarding the overall management of the surgical patient. In the last decade, ERAS has gained significant acceptance in the community of general surgery, in addition to several other surgical specialties, as the evidence of its advantages continues to grow. One of the last remaining fields, given its significant complexity and intricate nature, is liver transplantation (LT).
AIM
To investigate the existing efforts at implementing ERAS in LT.
METHODS
We conducted a systematic review of the existing studies that evaluate ERAS in orthotopic LT, with a multimodal approach and focusing on measurable clinical primary endpoints, namely length of hospital stay.
RESULTS
All studies demonstrated a considerable decrease in length of hospital stay, with no readmission or negative impact of the ERAS protocol applied to the postoperative course.
CONCLUSIONS
ERAS is a well-validated multimodal approach for almost all types of surgical procedures, and its future in selected LT patients seems promising, as the preliminary results advocate for the safety and efficacy of ERAS in the field of LT.
Core Tip: Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. The benefits of ERAS in liver transplantation seem promising, and further studies should be conducted to validate its application in properly selected patients.
