Retrospective Study
Copyright ©The Author(s) 2016.
World J Hepatol. Sep 18, 2016; 8(26): 1097-1104
Published online Sep 18, 2016. doi: 10.4254/wjh.v8.i26.1097
Table 1 Fast track protocol for cirrhotic patients undergoing liver resection
Fast track protocol for cirrhotic patients undergoing liver resection
Preoperative counseling
Regular diet on the day before surgery
No bowel preparation
Intraoperative CVP target < 6 mmHg, restricted fluids administration
ICU admission for at least the first post-operative night (or on POD 0)
Maintenance fluids discontinued on POD 3
Nasogastric probe removal on POD 1
Liquid diet on POD 1
Regular diet on POD 3
Urinary catheter discontinued on POD 3
Drains removal on POD 3
Ambulation on POD 3
Discharge criteria: Liver and kidney function tests compatible with preoperative data or decreasing, able to tolerate food intake, able to ambulate, good pain control (NRS < 3)
Table 2 Preoperative data
Group no epidural (n = 86)Group epidural (n = 40)P
Sex male (%)69 (80.2%)30 (75%)0.655
Age (yr)63.28 ± 11.3862.8 ± 11.920.832
BMI26.65 ± 4.3625.23 ± 5.500.155
Cirrhosis etiology
HBV19100.947
HCV49270.434
Alcohol920.501
Other1330.341
Type of resection
Major19120.461
Minor6728
Preoperative data
AST (UI/L)50.8 ± 47.446.9 ± 29.10.586
ALT(UI/L)47.4 ± 43.152.3 ± 38.50.541
Bilirubin (mg/dL)0.80 ± 0.430.77 ± 0.400.710
INR1.14 ± 0.121.10 ± 0.790.092
Creatinine (mg/dL)1.08 ± 1.240.87 ± 0.260.164
Urea (mg/dL)37.25 ± 13.7436.84 ± 11.790.867
Platelet count180134 ± 83856211079 ± 942620.088
Table 3 Intraoperative data
Group no epidural (n = 86)Group epidural (n = 40)P
Hemodynamic parameters
MAPBaseline94.4 ± 1289.5 ± 11.80.035
(mmHg)Post-resection77.3 ± 16.971.2 ± 9.70.041
(P = 0.004)End of surgery74.9 ± 10.774.9 ± 10.70.048
CVPBaseline8.26 ± 3.48.92 ± 3.150.323
(mmHg)Post-resection6.0 ± 3.255.76 ± 3.130.704
(P = 0.991)End of surgery7.35 ± 3.136.92 ± 2.570.466
Metabolic parameters
pHBaseline7.44 ± 0.0437.44 ± 0.0550.717
(P = 0.627)Post-resection7.40 ± 0.0537.39 ± 0.0530.608
End of surgery7.38 ± 0.5737.39 ± 0.0620.258
Lac (mmol/L)Baseline2.07 ± 3.151.98 ± 3.110.925
(P = 0.894)Post-resection4.22 ± 6.114.68 ± 7.400.800
End of surgery2.59 ± 2.202.62 ± 1.880.958
BE (mEq/L)Baseline1.27 ± 2.101.6 ± 1.940.563
(P = 0.343)Post-resection-1.93 ± 2.37-1.31 ± 2.610.354
End of surgery-2.72 ± 2.88-2.56 ± 2.920.499
Other data
Lenght of surgery (min)250.4 ± 93.48267.6 ± 88.970.326
Hypotension duration (min)2.28 ± 4.525.43 ± 6.680.006
Cristalloids infusions (mL)2768 ± 12132574 ± 10220.354
Colloids infusions (mL)259 ± 320428 ± 3120.007
RBC transfusions (U)0.06 ± 0.2390.01 ± 0.3040.470
Total diuresis (mL)467 ± 376552 ± 3840.248
Table 4 Post-operative data
Group no epidural (n = 86)Group epidural (n = 40)P
Hepatic function tests
AST (UI/L)POD 1205 ± 141238 ± 1680.239
(P = 0.451)POD 397 ± 6696 ± 540.334
POD 749 ± 2952 ± 260.636
ALT (UI/L)POD 1195 ± 161229 ± 2100.144
(P = 0.605)POD 3157 ± 126157 ± 1060.391
POD 767 ± 4773 ± 400.884
Bilirubin (mg/dL)POD 11.60 ± 1.01.60 ± 0.880.994
(P = 0.557)POD 31.8 ± 1.051.57 ± 0.810.306
POD 71.38 ± 1.061.26 ± 1.310.636
INRPOD 11.34 ± 0.181.31 ± 0.200.593
(P = 0.544)POD 31.31 ± 0.161.30 ± 0.250.899
POD 71.26 ± 0.141.12 ± 0.150.319
Platelet countPOD 1163649 ± 78332148015 ± 720070.647
(P = 0.532)POD 3148015 ± 72007132275 ± 435140.277
POD 7191073 ± 74978187586 ± 636020.827
Kidney function tests
Creatinine (mg/dL)POD 10.96 ± 0.870.87 ± 0.420.579
(P = 0.417)POD 30.98 ± 1.040.79 ± 0.290.331
POD 70.96 ± 1.150.78 ± 0.280.410
Urea (mg/dL)POD 133.37 ± 13.8732.86 ± 12.170.866
(P = 0.315)POD 338.0 ± 21.1733.79 ± 14.270.332
POD 735.57 ± 20.1329.76 ± 11.670.151
Table 5 Hospital length of stay and complications
Group no epidural (n = 86)Group epidural (n = 40)P
Post operative MV lenght (h)7.34 ± 18.111.29 ± 1.740.003
ICU stay (d)2.78 ± 2.352.43 ± 1.570.183
Total PO hospital stay (d)11.49 ± 7.958.65 ± 3.260.032
AKIN (grade)
081400.121
130
210
310
DINDO (grade)
130150.262
2199
3101
400
500