Ann Clin Surg | Volume 4, Issue 1 | Research Article | Open Access

Implementation of an ERAS Protocol on Cirrhotic Patients in Liver Resection

Reyes MP*, Pérez BS, González CS, Pérez Daga JA, Villalba JS and Santoyo JS

Hospital Regional Universitario de Málaga, Spain

*Correspondance to: María Pérez Reyes 

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Background: The development of laparoscopic liver surgery, the improvement in the perioperative care programs, and the surgical innovation has allowed liver resections on selected cirrhotic patients. However, the great majority of ERAS studies for liver surgery have been conducted on patients with normal liver parenchyma, while its application on cirrhotic patients is limited. The purpose of this study was to evaluate the implementation of an ERAS protocol in cirrhotic patients who underwent liver surgery. Methods: We present an analytical observational prospective cohort study, which included all adult patients who underwent a liver resection between December 2017 and December 2019 with an ERAS program. We compare the outcomes in patients Cirrhotic (CG)/Non-Cirrhotic (NCG). Results: A total of 101 patients were included. 30 of these (29.7%) were patients ≥ 70 cirrhotic. 87% of the both groups had performed >70% of the ERAS. Oral diet tolerance and mobilization on the first postoperative day were similar in both groups. The hospital stay was similar in both groups (2.9 days/2.99 days). Morbidity and mortality were similar; Clavien I-II (CG: 44% vs. NCG: 30%) and Clavien ≥ III (CG: 3% vs. NCG: 8%). Hospital re-entry was higher in the NCG. Overall mortality of the study was 1%. ERAS protocol compliance was associated with a decrease in complications (ERAS<70%: 80% vs. ERAS>90%: 20%; p=0.02) and decrease in severity of complications in both study groups. Conclusion: The application of the ERAS program in cirrhotic patients who undergo liver surgery is feasible, safe, and reproducible. It allows postoperative complications, mortality, hospital stay and readmission rates comparable to those in standard patients.


ERAS Protocol; Cirrhosis; Liver Resection


Reyes MP, Pérez BS, González CS, Pérez Daga JA, Villalba JS, Santoyo JS. Implementation of an ERAS Protocol on Cirrhotic Patients in Liver Resection. Ann Clin Surg. 2023; 4(2): 1028.

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