Effectiveness and cost analysis of enhanced recovery after surgery in patients underwent radical resection of hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JING Guanda ¹ , LIU Yuwei ² , HU Yanjie ¹ , LIANG Shiqi ¹ ,  LI Ka ¹

1. West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Nursing, Sichuan University/Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LI Ka, Email: lika127@126.com

Keywords：

enhanced recovery after surgery; liver resection; rehabilitation effect; hospitalization expense

DOI：

10.7507/1007-9424.202105004

Video：

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Objective To analyze the clinical effects and hospitalization costs of the enhanced recovery after surgery (ERAS) mode for patients underwent radical resection of hepatocellular carcinoma (HCC). Method The clinicopathologic data of adult patients who underwent radical resection of HCC in the West China Hospital of Sichuan University from January 2017 to December 2019 were collected retrospectively. Results A total of 1 082 patients were collected according to inclusion and exclusion criteria in this study, including 469 patients in the ERAS mode group and 613 patients in the traditional mode group. There were no significant differences in baseline data such as gender, age, body mass index, preoperative complications, operation type, and medical group between the two groups (P>0.05). Compared with the traditional mode group, the total hospitalization cost, medical service fee, examination fee, bed fee, and cooling and heating fee in the ERAS mode group were lower (P<0.05), the average total hospitalization time was shortened by about 1.2 d (P<0.01), the preoperative hospitalization time was shortened by about 0.3 d (P=0.03), and the postoperative hospitalization time was shortened by about 0.8 d (P<0.01) in the EARS mode group. There were no significant differences in the incidences of specific complications and total complications between the two groups (P>0.05). Conclusion ERAS for patients with HCC might play a role in improving rehabilitation efficiency and reducing hospitalization costs.

Citation： JING Guanda, LIU Yuwei, HU Yanjie, LIANG Shiqi, LI Ka. Effectiveness and cost analysis of enhanced recovery after surgery in patients underwent radical resection of hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(11): 1434-1438. doi: 10.7507/1007-9424.202105004 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	盛博, 张帮健, 杨昶. 控制性低中心静脉压联合急性高容性血液稀释在右半肝切除术中的应用. 四川医学, 2017, 38(12): 1403-1406.
3.	王润东, 荚卫东, 葛勇胜, 等. 加速康复外科方案在肝细胞癌手术的失败因素分析及风险预测模型的建立. 中华外科杂志, 2018, 56(9): 693-700.
4.	Morrison B, Kelliher L, Jones C. Enhanced recovery for liver resection-early recovery pathway for hepatectomy: data-driven liver resection care and recovery. Hepatobiliary Surg Nutr, 2018, 7(3): 217-220.
5.	李卡, 杨婕, 胡艳杰, 等. 加速康复外科模式在国内外应用的评价指标研究进展. 中国普外基础与临床杂志, 2018, 25(5): 629-634.
6.	中华医学会外科学分会外科手术学学组, 中国医疗保健国际交流促进会, 加速康复外科学分会肝脏外科学组. 肝切除术后加速康复中国专家共识(2017 版). 中华肝脏外科手术学电子杂志, 2017, 6(4): 254-260.
7.	李卡, 刘雨薇, 冯金华, 等. 加速康复外科模式在全髋关节置换术围术期管理中的临床研究. 四川大学学报(医学版), 2019, 50(4): 604-608.
8.	苏连珠, 孔祥琴, 杨容, 等. 快速康复护理对结直肠癌手术患者康复效率的分析及护理满意度的影响. 中外医疗, 2019, 38(26): 143-146.
9.	车国卫, 刘伦旭, 石应康. 加速康复外科临床应用现状与思考. 中国胸心血管外科临床杂志, 2016, 23(3): 211-215.
10.	Savikko J, Ilmakunnas M, Mäkisalo H, et al. Enhanced recovery protocol after liver resection. Br J Surg, 2015, 102(12): 1526-1532.
11.	Ni TG, Yang HT, Zhang H, et al. Enhanced recovery after surgery programs in patients undergoing hepatectomy: a meta-analysis. World J Gastroenterol, 2015, 21(30): 9209-9216.
12.	Liang X, Ying H, Wang H, et al. Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial. Surg Endosc, 2018, 32(6): 2746-2757.
13.	Qi S, Chen G, Cao P, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: a prospective randomized controlled trial. J Clin Lab Anal, 2018, 32(6): e22434.
14.	高敏, 冯金华, 张心怡, 等. 目标导向性液体治疗在肝癌肝叶切除术患者术后液体管理中的安全性及可行性研究. 四川医学, 2020, 41(10): 1021-1027.
15.	王越, 刘学民, 王博, 等. 术前天冬氨酸转氨酶/血小板比值指数对肝细胞癌患者手术切除后并发症的预测价值. 中华肝胆外科杂志, 2016, 22(5): 289-293.
16.	Amisaki M, Saito H, Tokuyasu N, et al. Prognostic value of postoperative complication for early recurrence after curative resection of hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2018, 17(4): 323-329.
17.	Khandoga A, Drefs M, Schoenberg M, et al. Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role? Eur J Gastroenterol Hepatol, 2017, 29(9): 1045-1053.
18.	Giovinazzo F, Kuemmerli C, Moekotte A, et al. The impact of enhanced recovery on open and laparoscopic liver resections. Updates Surg, 2020, 72(3): 649-657.
19.	Wang C, Zheng G, Zhang W, et al. Enhanced recovery after surgery programs for liver resection: a meta-analysis. J Gastrointest Surg, 2017, 21(3): 472-486.
20.	张有娣. 肝切除术 ERAS 临床护理路径的初步构建及应用研究. 兰州: 兰州大学, 2020.
21.	Kaibori M, Kubo S, Nagano H, et al. Clinicopathological features of recurrence in patients after 10-year disease-free survival following curative hepatic resection of hepatocellular carcinoma. World J Surg, 2013, 37(4): 820-828.
22.	黄兴华, 胡还章, 江艺. 加速康复外科在肝细胞癌根治术中的临床价值. 中华消化外科杂志, 2017, 16(2): 164-169.
23.	李卡, 冯金华, 胡艳杰, 等. 医疗供给侧改革下加速康复外科应用. 解放军医院管理杂志, 2016, 23(12): 1140-1143.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 盛博, 张帮健, 杨昶. 控制性低中心静脉压联合急性高容性血液稀释在右半肝切除术中的应用. 四川医学, 2017, 38(12): 1403-1406.
3. 王润东, 荚卫东, 葛勇胜, 等. 加速康复外科方案在肝细胞癌手术的失败因素分析及风险预测模型的建立. 中华外科杂志, 2018, 56(9): 693-700.
4. Morrison B, Kelliher L, Jones C. Enhanced recovery for liver resection-early recovery pathway for hepatectomy: data-driven liver resection care and recovery. Hepatobiliary Surg Nutr, 2018, 7(3): 217-220.
5. 李卡, 杨婕, 胡艳杰, 等. 加速康复外科模式在国内外应用的评价指标研究进展. 中国普外基础与临床杂志, 2018, 25(5): 629-634.
6. 中华医学会外科学分会外科手术学学组, 中国医疗保健国际交流促进会, 加速康复外科学分会肝脏外科学组. 肝切除术后加速康复中国专家共识(2017 版). 中华肝脏外科手术学电子杂志, 2017, 6(4): 254-260.
7. 李卡, 刘雨薇, 冯金华, 等. 加速康复外科模式在全髋关节置换术围术期管理中的临床研究. 四川大学学报(医学版), 2019, 50(4): 604-608.
8. 苏连珠, 孔祥琴, 杨容, 等. 快速康复护理对结直肠癌手术患者康复效率的分析及护理满意度的影响. 中外医疗, 2019, 38(26): 143-146.
9. 车国卫, 刘伦旭, 石应康. 加速康复外科临床应用现状与思考. 中国胸心血管外科临床杂志, 2016, 23(3): 211-215.
10. Savikko J, Ilmakunnas M, Mäkisalo H, et al. Enhanced recovery protocol after liver resection. Br J Surg, 2015, 102(12): 1526-1532.
11. Ni TG, Yang HT, Zhang H, et al. Enhanced recovery after surgery programs in patients undergoing hepatectomy: a meta-analysis. World J Gastroenterol, 2015, 21(30): 9209-9216.
12. Liang X, Ying H, Wang H, et al. Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial. Surg Endosc, 2018, 32(6): 2746-2757.
13. Qi S, Chen G, Cao P, et al. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: a prospective randomized controlled trial. J Clin Lab Anal, 2018, 32(6): e22434.
14. 高敏, 冯金华, 张心怡, 等. 目标导向性液体治疗在肝癌肝叶切除术患者术后液体管理中的安全性及可行性研究. 四川医学, 2020, 41(10): 1021-1027.
15. 王越, 刘学民, 王博, 等. 术前天冬氨酸转氨酶/血小板比值指数对肝细胞癌患者手术切除后并发症的预测价值. 中华肝胆外科杂志, 2016, 22(5): 289-293.
16. Amisaki M, Saito H, Tokuyasu N, et al. Prognostic value of postoperative complication for early recurrence after curative resection of hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2018, 17(4): 323-329.
17. Khandoga A, Drefs M, Schoenberg M, et al. Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role? Eur J Gastroenterol Hepatol, 2017, 29(9): 1045-1053.
18. Giovinazzo F, Kuemmerli C, Moekotte A, et al. The impact of enhanced recovery on open and laparoscopic liver resections. Updates Surg, 2020, 72(3): 649-657.
19. Wang C, Zheng G, Zhang W, et al. Enhanced recovery after surgery programs for liver resection: a meta-analysis. J Gastrointest Surg, 2017, 21(3): 472-486.
20. 张有娣. 肝切除术 ERAS 临床护理路径的初步构建及应用研究. 兰州: 兰州大学, 2020.
21. Kaibori M, Kubo S, Nagano H, et al. Clinicopathological features of recurrence in patients after 10-year disease-free survival following curative hepatic resection of hepatocellular carcinoma. World J Surg, 2013, 37(4): 820-828.
22. 黄兴华, 胡还章, 江艺. 加速康复外科在肝细胞癌根治术中的临床价值. 中华消化外科杂志, 2017, 16(2): 164-169.
23. 李卡, 冯金华, 胡艳杰, 等. 医疗供给侧改革下加速康复外科应用. 解放军医院管理杂志, 2016, 23(12): 1140-1143.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effectiveness and cost analysis of enhanced recovery after surgery in patients underwent radical resection of hepatocellular carcinoma

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