The impact of enhanced recovery program compliance after elective liver surgery: Results from a multicenter prospective national registry

Background: The Enhanced Recovery Program after surgery is a multimodal, evidence-based protocol of care developed to minimize the response to surgical stress. Data on the influence of ERP on outcomes, particularly according to the complexity of liver surgery, are lacking. Methods: A prospective multicenter cohort of patients undergoing liver surgery and exposed to Enhanced Recovery Program from 2016 to 2020 in France was analyzed. High Enhanced Recovery Program compliance was defined as more than 70% of items (15 out of 21). The outcomes were the rate of complications, length of stay, and functional recovery according to Enhanced Recovery Program compliance. Results: A total of 297 patients were included in the study, and they had 61.9% overall compliance (median = 13 items, interquartile range 11-15). Complications were observed in 32.2% (n = 95) of cases, and the mean length of hospital stay was 7.28 (+/- 7.15) days overall. A longer duration of liver surgery was associated with an increase in the complication rate, while high compliance was independently associated with a reduced risk of complications in the multivariable analysis. Conclusion: High Enhanced Recovery Program compliance was associated with a lower rate of postoperative complications. (c) 2021 Elsevier Inc. All rights reserved.