Authors (including presenting author) :
Sit J(1), Yu MWV(1)
Affiliation :
(1)Department of Dietetics, Queen Mary Hospital
Introduction :
Enhanced recovery after surgery(ERAS) involved multidisciplinary care which attenuates perioperative stress and promote early recovery. ERAS program is associated with lower morbidity, shortened postoperative stay and reduced cost.
Objectives :
Traditionally, carbohydrate loading was provided to patients 2 hours before surgery with international data of length of stay(LOS) of 4-8 days. Carbohydrate loading was provided 4 hours before surgery in Queen Mary Hospital(QMH) according to the ERAS protocol. The aim of this study was to evaluate whether earlier carbohydrates loading was equally efficacious in ERAS liver surgery.
Methodology :
Protocol for ERAS(hepatectomy) was developed and commenced in September 2020 in QMH. Patients were assessed for malnutrition with CMUST. Before surgery, dietetics referral would be made if nutrition buildup or counselling is deemed. Preoperative fasting was prevented. Carbohydrate loading (50g Polycal dissolved in 400ml water) was consumed by patients 4 hours before surgery. Early postoperative oral intake was allowed with nutrition supplement provided if needed.
Result & Outcome :
From September 2020 to December 2021, 32 patients underwent hepatectomy under ERAS pathway in QMH. There were 23(71%)men and 9(28%) women with average age 62±8years old (35–72 years old). Their mean body weight at admission was 67.6 kg with BMI 24.8 ± 3.2kg/m2. Among them, 29(91%) patients suffered from malignant disease. Half of the patients had surgery on the same day of admission. Oral nutrition supplement was provided to 26(81.2%) patients. LOS since admission and after surgery(ALOS) were found to be 4.7±1.8 days and 4.1±1.5 days respectively. Plasma albumin dropped from 43±4g/L before hepatectomy to 36±5g/L after operation.
Patients undergoing liver surgery on the day of admission had significantly(p=0.00) shorter LOS(3.3±1.0 days) than those with surgery carried out not on the day of admission (5.0±1.3 days). No significant difference were found in plasma albumin and LOS between patient group with or without co-morbidities(diabetes, lipid, renal impairment), age or sex.
LOS in the current study(4.7 days) was comparable to Hong Kong’s cohort(4.9 days), Portugal’s(3.9 days), UK’s(4 days) and France’s(4 days) while shorter than China’s (6-8 days) and Korea’s(5.8 days). ERAS hepatectomy on the day of admission seemed to be as effective as or even better than those carried out at later days. Amended carbohydrate loading at 4 hours before surgery than universally suggested 2 hours was found to be equally efficacious. ERAS pathway engaging multidisciplinary care with nutrition support played an important role.
