The Application Of Enhanced Recoveryafter Surgery Based On Propensity Score Matching Analysis In Perioperative Period Of Hepatectomy For Primary Liver Cancer

Objective: To investigate the application and efficacy evaluation of enhanced recovery after surgery(ERAS)in the perioperative period of hepatectomy for primary liver cancer,and then provide more evidence based medicine for the application and promotion of ERAS in perioperative period of patients who undergo hepatectomy for primary liver cancer.Method: A retrospective cohort study was conducted to collect 109 cases in department of hepatopancreatobiliary surgery of hepatectomy for primary liver cancer from January 1,2014 to September 30,2018 in the First Affiliated Hospital of USC.The enrolled patients were divided into enhanced recovery after surgery(experimental group,n=56)an-d traditional group(control group,n=53)according to the perioperative management process.The patient was subjected to a one-to-one propensity case-matched analysis(specifically,caliper matching method),which was used with covariates of baseline characteristics,including the patient's basic condition and tumor characteristics,and the perioperative clinical efficacy of the two groups was compared.Observation indicators:(1)Intraoperative conditions: operation time,intraoperative blood loss,intraoperative blood transfusion cases.(2)Clinical pathological results: degree of differentiation,presence or absence of microvascular invasion,and presence or absence of pathological margin.(3)Postoperative laboratory observations: Postoperative day(POD)1,4,7 daysof white blood cells(WBC),albumin(ALB),hemoglobin(HGB),Total bilirubin(TBIL),direct bilirubin(DBIL),Alanine aminotransferase(ALT),and Aspartate aminotransferase(AST)values.(4)Postoperative clinical observation indicators:postoperative hospital stay,total hospitalization expenses,oral feeding time,the leaving bed time,first exhaust time,and abdominal drainage tube removal time.(5)Postoperative complications:incidence of moderate to severe pain,bile leakage,abdominal hemorrhage,pulmonary infection,incision infection and readmission rate of 30 days after surgery.Results:Patients in the ERAS and conventional groups were well balanced after the preference matching score of gender,age,hepatitis,cirrhosis,Child-Pugh score for liver function,Alpha fetoprotein(AFP),tumor size,American Standards Association(ASA),The position of the difficult tumor,these were well balanced after the preference matching score,and 40 patients in each group after the matching.Both groups of patients were discharged smoothly,and no perioperative death occurred.(1)Intraoperative conditions:There were no significant differences in the operation time,intraoperative blood loss and blood transfusion between the ERAS group and the conventional group(P>0.05).(2)Clinical pathological results:There was no significant difference between the ERAS group and the traditional group in the degree of tumor differentiation,microvascular invasion and pathological margin(P>0.05).(3)Postoperative laboratory observations:The white blood cell counts at 1,4,and 7 days after operation were significantly lower in the ERAS group than in the conventional group(P<0.05).The levels of albumin at 1,4,and 7 days after surgery were significantly higher in the ERAS group.In the traditional group,the difference was statistically significant(P<0.05).There was no significant difference between the two groups in hemoglobin,alanine aminotransferase,aspartate aminotransferase,total bilirubin and direct bilirubin(P>0.05).(4)Compared with the traditional group,patients in the ERAS group had shorter postoperative feeding time,the leaving bed time,postoperative first exhaust time,postoperative drainage tube removal time,postoperative hospital stay,and fewer hospitalizations.The total cost and the incidence of moderate to severe pain were statistically significant,The difference was statistically significant(P<0.05).(5)Postoperative complications: There was no significant difference in the incidence of complications between the ERAS group and the traditional group and the readmission rate within 30 days after surgery(P>0.05).Conclusion: The ERAS is safe and effective in the perioperative period of primary liver cancer.It can effectively reduce postoperative inflammatory response,reduce postoperative pain,reduce postoperative hospitalization time,hospitalization cost and complications.It can also accelerate postoperative the recovery of postoperative patients and save medical resources.