A Commentary on “Enhanced recovery after surgery protocols in patients undergoing liver transplantation: A retrospective comparative cohort studyˮ [Int. J. Surg. 78 2020 108–22]

2020 ◽  
Vol 79 ◽  
pp. 249
Author(s):  
Hu Qiang ◽  
Sun Yuanshui
Keyword(s):  
Liver Transplantation ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery

scholarly journals Fast-Track Liver Transplantation: Six-year Prospective Cohort Study with an Enhanced Recovery After Surgery (ERAS) Protocol

2021 ◽  
Author(s):  
Gonzalo P. Rodríguez-Laiz ◽  
Paola Melgar-Requena ◽  
Cándido F. Alcázar-López ◽  
Mariano Franco-Campello ◽  
Celia Villodre-Tudela ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cohort Study ◽  
Length Of Stay ◽  
Liver Transplant ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fluid Restriction

Abstract Introduction Enhanced recovery after surgery (ERAS) has been shown to facilitate discharge, decrease length of stay, improve outcomes and reduce costs. We used this concept to design a comprehensive fast-track pathway (OR-to-discharge) before starting our liver transplant activity and then applied this protocol prospectively to every patient undergoing liver transplantation at our institution, monitoring the results periodically. We now report our first six years results. Patients and methods Prospective cohort study of all the liver transplants performed at our institution for the first six years. Balanced general anesthesia, fluid restriction, thromboelastometry, inferior vena cava preservation and temporary portocaval shunt were strategies common to all cases. Standard immunosuppression administered included steroids, tacrolimus (delayed in the setting of renal impairment, with basiliximab induction added) and mycophenolate mofetil. Tacrolimus dosing was adjusted using a Bayesian estimation methodology. Oral intake and ambulation were started early. Results A total of 240 transplants were performed in 236 patients (191♂/45♀) over 74 months, mean age 56.3±9.6 years, raw MELD score 15.5±7.7. Predominant etiologies were alcohol (n = 136) and HCV (n = 82), with hepatocellular carcinoma present in 129 (54.7%). Nine patients received combined liver and kidney transplants. The mean operating time was 315±64 min with cold ischemia times of 279±88 min. Thirty-one patients (13.1%) were transfused in the OR (2.4±1.2 units of PRBC). Extubation was immediate (< 30 min) in all but four patients. Median ICU length of stay was 12.7 hours, and median post-transplant hospital stay was 4 days (2-76) with 30 patients (13.8%) going home by day 2, 87 (39.9%) by day 3, and 133 (61%) by day 4, defining our fast-track group. Thirty-day-readmission rate (34.9%) was significantly lower (28.6% vs. 44.7% p=0.015) in the fast-track group. Patient survival was 86.8% at 1 year and 78.6% at five years. Conclusion Fast-Tracking of Liver Transplant patients is feasible and can be applied as the standard of care

Abdominal Organ Transplantation: Noteworthy Literature in 2019

2020 ◽  
Vol 24 (2) ◽  
pp. 159-174
Author(s):  
Diana N. Romano ◽  
Natalie K. Smith ◽  
Corey R. Vasisko ◽  
Jeron Zerillo ◽  
Tetsuro Sakai
Keyword(s):  
Liver Transplantation ◽  
Clinical Trials ◽  
Organ Transplantation ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Perioperative Complications ◽  
Intestinal Transplantation ◽  
Abdominal Organ ◽  
Pancreatic Transplantation

In the year 2019, we identified and screened over 400 peer-reviewed publications on pancreatic transplantation, over 200 on intestinal transplantation, and over 1900 on kidney transplantation. The liver transplantation section focuses on and features selected articles among 70 clinical trials published in 2019. This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We explore a broad range of topics, including risks for and prediction of perioperative complications, updated indications for transplantation, recommendations on perioperative management, including Enhanced Recovery After Surgery programs, and topics relevant to optimization of patient and graft outcomes and survival.

Psychological influences on wound healing

2019 ◽  
Vol 98 (8) ◽  
pp. 312-314
Keyword(s):  
Wound Healing ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Wound Complications ◽  
State Of Mind ◽  
Life Threatening ◽  
Psychological Influences ◽  
Fear And Anxiety ◽  
Care Costs

Surgical wound complications remain a major cause of morbidity; although usually not life threatening, they reduce the quality of life. They are also associated with excessive health care costs. Wound healing is affected by many factors – wound characteristics, infection, comorbidities and nutritional status of the patient. In addition, though, psychological stress and depression may decrease the inflammatory response required for bacterial clearance and so delay wound healing, as well. Although the patient´s state of mind can be influenced only to a certain extent, we should nevertheless stick to ERAS (Enhanced Recovery After Surgery) guidelines and try to diminish fear and anxiety by providing enough information preoperatively, pay due attention to postoperative analgesia and seek to provide an agreeable environment.

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