Role Of Enhanced Recovery After Surgery (ERAS) In Hepatobiliary Surgery: Reducing Complications And Length Of Stay

Abstract

Background: Hepatobiliary surgery is a complex and high-risk field, often requiring long and complicated recovery periods. Enhanced Recovery After Surgery (ERAS) protocols have been introduced to optimize recovery by addressing key factors such as pain management, early mobilization, and nutritional support. These protocols aim to reduce complications and promote quicker recovery, but their effectiveness in hepatobiliary surgery remains uncertain. Objective: This study aimed to evaluate the impact of ERAS protocols on postoperative outcomes in hepatobiliary surgery, particularly focusing on pain management, length of ICU and hospital stays, and complications. Method: A prospective cohort study was conducted on patients undergoing hepatopancreatobiliary (HPB) surgeries at North East Medical College Hospital, Sylhet, Bangladesh, from January 2024 to December 2024. Patients were divided into two groups: the ERAS group (n=50) and the control group (n=45). Both groups received similar preoperative care, with the ERAS group following a structured postoperative recovery plan. Data on demographic details, surgical procedures, postoperative complications, length of ICU and hospital stays, and pain scores were collected and analyzed using SPSS software. Results: There were no significant differences in ICU stay (1.7 ± 2.2 days vs. 1.5 ± 0.8 days, p=0.735) or hospital stay (6.19 ± 6 days vs. 6.44 ± 5.2 days, p=0.645) between the ERAS and control groups. However, the ERAS group demonstrated significantly lower pain scores (3.4 ± 0.77 vs. 4.47 ± 0.88, p<0.001). The ERAS group also had a higher percentage of patients requiring blood transfusions (12.8% vs. 9.3%) and NG tube re-insertion (12.8% vs. 4.7%), though these differences were not statistically significant. Postoperative complications were slightly more common in the ERAS group (25.5% vs. 20.9%, p=0.628). Conclusion: The ERAS protocols significantly improved pain management in hepatobiliary surgery, as evidenced by lower VAS scores in the ERAS group. While there were no significant differences in ICU stay, hospital stay, or complications, ERAS protocols appear to optimize recovery by reducing pain. Further studies are needed to evaluate the broader impact of ERAS on other postoperative complications and long-term recovery outcomes.