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

Br J Surg. 2013 Jan;100(1):138-43. doi: 10.1002/bjs.8996. Epub 2012 Nov 20.


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.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / secondary
  • Carcinoma, Hepatocellular / surgery
  • Female
  • Hepatectomy / adverse effects
  • Hepatectomy / methods
  • Hepatectomy / rehabilitation*
  • Hepatectomy / statistics & numerical data*
  • Humans
  • Laparoscopy / rehabilitation
  • Length of Stay*
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery
  • Male
  • Middle Aged
  • Pain / etiology
  • Perioperative Care / methods*
  • Perioperative Care / statistics & numerical data*
  • Program Evaluation
  • Prospective Studies
  • Young Adult