Anushka Jindal
Introduction
Enhanced Recovery After Surgery (ERAS) pathways improve perioperative recovery, reduce complications, and shorten hospital stay after hepatectomy. At a tertiary care centre, an ERAS pathway for liver resections was introduced, but earlier audit cycles identified poor uptake and inconsistent adherence, particularly around preoperative carbohydrate loading, postoperative nutritional support, physiotherapy review, and follow-up.
Objective
To assess adherence to the hepatectomy ERAS protocol across two audit cycles and evaluate the impact of targeted service improvements.
Methods
This clinical audit reviewed elective open and laparoscopic hepatectomies meeting local ERAS inclusion criteria. Extended hepatectomies, emergency operations, diabetic patients, and combined procedures were excluded. Cycle-1 evaluated cases from January to March; Cycle-2 assessed cases in June after interventions addressing previously identified barriers. These included workflow changes across clinic, preoperative, perioperative, postoperative, and discharge phases, alongside resolution of EPIC integration issues in June 2024.
Results
In Cycle-1, 31 hepatectomies were performed and 24 met ERAS criteria. Only 8/24 patients were managed on ERAS pathway. Barriers included limited ERAS nurse capacity, clinic space constraints, poor communication, inconsistent prescribing/documentation & EPIC workflow limitations. In Cycle-2, four hepatectomies were performed, with three eligible cases and 100% adherence to ERAS. Activity during this period was affected by multiple case cancellations related to the Synnovis cyber-attack.
Conclusion
Initial ERAS uptake for hepatectomy was low but improved markedly following targeted organisational and electronic workflow changes. Sustained consultant engagement, timely ERAS booking, and protected preassessment capacity may help maintain compliance.
Authors
Anushka Jindal, Bart's Health NHS Trust, London, United Kingdom