Factors predicting lower hospital stay after liver transplantation using a comprehensive enhanced recovery after surgery (ERAS) protocol.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-03-10 DOI:10.1016/j.hpb.2025.03.001

Paola Melgar, Celia Villodre, Cándido Alcázar, Mariano Franco, Juan J Rubio, Pedro Zapater, Patricio Más, Sonia Pascual, Gonzalo P Rodríguez-Laiz, José M Ramia

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引用次数: 0

Abstract

Introduction: Enhanced recovery after surgery (ERAS) protocols facilitate patient recovery without increasing complication rates. An ERAS protocol designed for our liver transplant (LT) patients obtained a median hospital length of stay (LOS) of 4 days. However, a proportion of patients do not achieve early discharge. This study aimed to identify factors that predict an LOS≤ 4 days.

Methods: Identifying factors associated with LOS <4 days in our LT patients.

Results: We performed 293 LTs (2012-2021), LOS≤4 days in 171 (58.4 %). The following factors emerged as statistically predictors of LOS≤4 days in the univariate analysis: male sex, HCC or HCV patients, lower MELD score, lower BAR score, no DCD patients, shorter operative time, no intraoperative transfusion, shorter ICU stay, no Clavien-Dindo complications grade ≥ III, no primary graft dysfunction, no acute rejection, no readmission at 30 days and no retransplantation were associated to LOS≤4 days. However, in the multivariate analysis, the only independent risk factor that predicted LOS≤4 days was the presence of hepatocarcinoma. DCD donors and higher MELD score were negative factors.

Conclusions: Applying ERAS programs in LT patients is beneficial, safe and extensible to all patients, but those with hepatocarcinoma obtain higher rates of LOS≤4 days.

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肝移植术后综合增强术后恢复（ERAS）方案缩短住院时间的预测因素

简介：增强术后恢复（ERAS）方案促进患者恢复而不增加并发症发生率。为我们的肝移植（LT）患者设计的ERAS方案获得了4天的中位住院时间（LOS）。然而，仍有一部分患者未能早日出院。本研究旨在确定预测LOS≤4天的因素。结果：我们进行了293例LTs(2012-2021)，其中171例（58.4%）的LOS≤4天。在单因素分析中，以下因素作为LOS≤4天的统计预测因素：男性、HCC或HCV患者、较低的MELD评分、较低的BAR评分、无DCD患者、较短的手术时间、无术中输血、较短的ICU住院时间、无Clavien-Dindo并发症≥III级、无原发性移植物功能障碍、无急性排斥反应、30天无再入院和无再移植与LOS≤4天相关。然而，在多变量分析中，预测LOS≤4天的唯一独立危险因素是肝癌的存在。DCD供者和较高的MELD评分为负性因素。结论：在LT患者中应用ERAS方案是有益的、安全的，并可扩展到所有患者，但肝癌患者的LOS≤4天的发生率更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).