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, 張幫健, 楊昶. 控制性低中心靜脈壓聯合急性高容性血液稀釋在右半肝切除術中的應用. 四川醫學, 2017, 38(12): 1403-1406.
3.	王潤東, 莢衛東, 葛勇勝, 等. 加速康復外科方案在肝細胞癌手術的失敗因素分析及風險預測模型的建立. 中華外科雜志, 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, 楊婕, 胡艷杰, 等. 加速康復外科模式在國內外應用的評價指標研究進展. 中國普外基礎與臨床雜志, 2018, 25(5): 629-634.
6.	中華醫學會外科學分會外科手術學學組, 中國醫療保健國際交流促進會, 加速康復外科學分會肝臟外科學組. 肝切除術后加速康復中國專家共識(2017 版). 中華肝臟外科手術學電子雜志, 2017, 6(4): 254-260.
7.	李卡, 劉雨薇, 馮金華, 等. 加速康復外科模式在全髖關節置換術圍術期管理中的臨床研究. 四川大學學報(醫學版), 2019, 50(4): 604-608.
8.	蘇連珠, 孔祥琴, 楊容, 等. 快速康復護理對結直腸癌手術患者康復效率的分析及護理滿意度的影響. 中外醫療, 2019, 38(26): 143-146.
9.	車國衛, 劉倫旭, 石應康. 加速康復外科臨床應用現狀與思考. 中國胸心血管外科臨床雜志, 2016, 23(3): 211-215.
10.	Savikko J, Ilmakunnas M, M?kisalo 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, 馮金華, 張心怡, 等. 目標導向性液體治療在肝癌肝葉切除術患者術后液體管理中的安全性及可行性研究. 四川醫學, 2020, 41(10): 1021-1027.
15.	王越, 劉學民, 王博, 等. 術前天冬氨酸轉氨酶/血小板比值指數對肝細胞癌患者手術切除后并發癥的預測價值. 中華肝膽外科雜志, 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.	張有娣. 肝切除術 ERAS 臨床護理路徑的初步構建及應用研究. 蘭州: 蘭州大學, 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.	黃興華, 胡還章, 江藝. 加速康復外科在肝細胞癌根治術中的臨床價值. 中華消化外科雜志, 2017, 16(2): 164-169.
23.	李卡, 馮金華, 胡艷杰, 等. 醫療供給側改革下加速康復外科應用. 解放軍醫院管理雜志, 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, 張幫健, 楊昶. 控制性低中心靜脈壓聯合急性高容性血液稀釋在右半肝切除術中的應用. 四川醫學, 2017, 38(12): 1403-1406.
3. 王潤東, 莢衛東, 葛勇勝, 等. 加速康復外科方案在肝細胞癌手術的失敗因素分析及風險預測模型的建立. 中華外科雜志, 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, 楊婕, 胡艷杰, 等. 加速康復外科模式在國內外應用的評價指標研究進展. 中國普外基礎與臨床雜志, 2018, 25(5): 629-634.
6. 中華醫學會外科學分會外科手術學學組, 中國醫療保健國際交流促進會, 加速康復外科學分會肝臟外科學組. 肝切除術后加速康復中國專家共識(2017 版). 中華肝臟外科手術學電子雜志, 2017, 6(4): 254-260.
7. 李卡, 劉雨薇, 馮金華, 等. 加速康復外科模式在全髖關節置換術圍術期管理中的臨床研究. 四川大學學報(醫學版), 2019, 50(4): 604-608.
8. 蘇連珠, 孔祥琴, 楊容, 等. 快速康復護理對結直腸癌手術患者康復效率的分析及護理滿意度的影響. 中外醫療, 2019, 38(26): 143-146.
9. 車國衛, 劉倫旭, 石應康. 加速康復外科臨床應用現狀與思考. 中國胸心血管外科臨床雜志, 2016, 23(3): 211-215.
10. Savikko J, Ilmakunnas M, M?kisalo 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, 馮金華, 張心怡, 等. 目標導向性液體治療在肝癌肝葉切除術患者術后液體管理中的安全性及可行性研究. 四川醫學, 2020, 41(10): 1021-1027.
15. 王越, 劉學民, 王博, 等. 術前天冬氨酸轉氨酶/血小板比值指數對肝細胞癌患者手術切除后并發癥的預測價值. 中華肝膽外科雜志, 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. 張有娣. 肝切除術 ERAS 臨床護理路徑的初步構建及應用研究. 蘭州: 蘭州大學, 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. 黃興華, 胡還章, 江藝. 加速康復外科在肝細胞癌根治術中的臨床價值. 中華消化外科雜志, 2017, 16(2): 164-169.
23. 李卡, 馮金華, 胡艷杰, 等. 醫療供給側改革下加速康復外科應用. 解放軍醫院管理雜志, 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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