Document Type

Clinical Science Research

Date of Poster



The implementation of ERAS for major hepatectomy in a U.S. veteran population translates into decreased hospital LOS and perioperative opioid consumption. This not only represents a novel use of ERAS in this population but also provides some of the first evidence that continuous ESP catheters can be effective for open hepatectomy within an ERAS pathway. Future directions include expanding this ERAS pathway on a larger scale to compare the benefit of continuous ESPs versus thoracic epidural for pain control.

Date of Submission

May 2020



Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery, however, evidence is lacking in major liver surgery, .This study aimed to evaluate the impact of an ERAS pathway in U.S. veterans undergoing major hepatectomy surgery. We hypothesized that the adoption of an ERAS pathway reduces decreased length of stay (LOS).


After approval from the Hunter Holmes McGuire VA Medical Center IRB, we compared data from consecutive patients undergoing elective open hepatectomy within an ERAS pathway (January 2019-December 2019) to a previous cohort of patients before introduction of ERAS (July 2016-December 2017). One surgeon performed all the procedures. LOS and perioperative narcotic usage were analyzed for both cohorts. Pre-operative components of the protocol included patient education, avoidance of bowel preparation, and consumption of clear carbohydrate drinks until two hours prior to surgery. Intraoperative measures included standardized anesthetic management, minimizing the use of opiates, and favoring regional anesthesia. Post-operative components included avoidance of nasogastric tubes, encouragement of liquids immediately after surgery, and early ambulation.


A total of 24 patients were evaluated. Eight completed the ERAS pathway versus sixteen in the traditional group. There was a clinically significant reduction in LOS in the ERAS group (7.5 days +/- 4.9) compared to traditional care (10 +/- 5.9, p=0.07). Patient in the ERAS group also had lower intraoperative morphine equivalent consumption (65.6mg +/-38.6) than the control group (104.7mg +/- 38.7, p=0.04) and less need for postoperative PCA (0% vs 73%, p=0.00046).


The implementation of ERAS for major hepatectomy in a U.S. Veteran population translates into decreased LOS and perioperative opioid consumption.


© The Author

Is Part Of

VCU School of Medicine GME Resident and Fellow Research Day Posters

Recommended Citation

1. Greer NL, Gunnar WP, Dahm P, Lee AE, MacDonald R, Shaukat A, Sultan S, Wilt TJ. Enhanced Recovery Protocols for Adults Undergoing Colorectal Surgery: A Systematic Review and Meta-analysis. Dis Colon Rectum. 2018;61:1108–1118 2. Thornblade, Lucas W et al. “Enhanced Recovery via Peripheral Nerve Block for Open Hepatectomy.” Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract vol. 22,6 (2018): 981-988. doi:10.1007/s11605-017-3656-y 3. Bruns H, Krätschmer K, Hinz U, et al. Quality of life after curative liver resection: a single center analysis. World J Gastroenterol. 2010;16(19):2388‐2395. doi:10.3748/wjg.v16.i19.2388 4. Greer N, Sultan S, Shaukat A, et al. Enhanced Recovery After Surgery (ERAS) Programs for Patients Undergoing Colorectal Surgery [Internet]. Washington (DC): Department of Veterans Affairs (US); 2017 Aug. Available from: