The Generation And Application Of An Enhanced Recovery After Surgery (ERAS)Strategy Following Liver Transplantation

Objectives:1.To establish the enhanced recovery after surgery(ERAS)strategy with the health-care integration systems following liver transplantation on the basis of evidence-based medicine.2.To evaluate the effectiveness of the ERAS strategy on liver transplantation recipients by clinical research.Methods:This research was divided into two parts:Part I The generation of ERAS strategy following liver transplantationIn terms of key words "liver transplantation/orthotropic liver transplantation" and"enhanced recovery after surgery/ERAS" or "fast track surgery/FTS",literature and practical guidelines from January 1997 to February 2015 was simultaneously searched in databases search was simultaneously performed in databases including PubMed,The Cochrane Library,Web of Science,Joanna Briggs Institute(JBI)evidence-based health care database,China National Knowledge Infrastructure(CNKI).According to the including criteria,three clinical practice guidelines,three systematic reviews and four randomized controlled trials were enrolled in this analysis.The ERAS strategy with the health-care integration systems following liver transplantation had been established ultimately by the best available evidence summary together with clinical practice and evidence.Part Ⅱ Clinical application study of ERAS strategy following liver transplantationThe clinical data of 62 patients who underwent liver transplantation in hepatopancreatobiliary surgery department between February 2012 to December 2017 were collected retrospectively.Of the 62 patients,36 recipients treated with an ERAS strategy following liver transplantation(ERAS group),were compared to the historical cohort of 26 patients,managed with traditional perioperative care before March 2015(Traditional group).The incidence following liver transplantation and stage of postoperative complications,several recovery indexes in the early postoperative period such as duration of tracheal intubation,nasogastric tube and urinary catheter,the time for first bowel movement,the time for the first ambulation,postoperative hospital and ICU stay,number of unplanned readmission within 30 days after discharge and hospitalization costs were analyzed and compared between the two groups.Results:1.The generation of ERAS strategy following liver transplantation(see table 2.1).2.After the implementation of ERAS strategy following liver transplantation,the incidence of complications was decreased slightly after liver transplantation(88.9%vs 92.3%).Whereas there was a lower severe complication(Grade Ⅲ～Ⅴ complication)rate in ERAS group evidently,which indicated significant difference between these two groups(p=0.002).3.After the implementation of ERAS strategy following liver transplantation,the postoperative recovery process of liver transplantation recipients was accelerated and the duration of tracheal intubation was shortened significantly(p<0.05).Furthermore,both duration of nasogastric tube and urinary catheter shortened,and the first bowel movement and ambulation took place ahead of schedule,which demonstrated that the difference was significant(p≤ 0.001).4.After the implementation of ERAS strategy following liver transplantation,duration of postoperative ICU stay and hospital stay shorten significantly(p<0.001).The rate of unplanned and readmission was not significant statistical difference(p>0.05).5.The average of total hospitalization costs for liver transplantation recipients was decreased from 264300.00 yuan to 211440.65 yuan as the application of the ERAS strategy following liver transplantation,which showed significant difference(p<0.05).Conclusion:ERAS strategy with the health-care integration systems based on evidence-based medicine is safe and feasible following liver transplantation,which can reduce the incidence of severe complications and accelerate the postoperative recovery process for liver transplantation recipients,shorten duration of postoperative hospital stay and decrease total hospitalization costs to a large extent.It should be pointed out that the significance of the nurses in our ERAS strategy cannot be underestimated.On the one hand nurses serve as a meaningful bridge in the relationship between patients and doctors.On the other hand,the passionate participation of nurses acts as a valuable prerequisite for the successful implementation of our ERAS strategy.