Liver Surgery
Conditions
Brief summary
Enhanced rehabilitation programs are based on new therapies and treatment combinations to reduce the length of hospitalization, duration of postoperative convalescence, morbidity, but also the overall cost of care. The operating stress and hypercatabolic conditions surrounding the surgery are sources of complications. In this enhanced rehabilitation approach, the principle is to fight through a series of actions against this surgical stress. Several North American studies, Chinese, Scandinavian or Batavian have shown the feasibility and the interest of enhanced perioperative rehabilitation in liver surgery. Nevertheless, there is not until now French data concerning the assessment of enhanced rehabilitation in liver surgery. The main objective of the study is to compare the effectiveness of the implementation of a multimodal management program after liver surgery in a French university center compared to conventional care. Secondary objectives of the study are to compare an enhanced rehabilitation program in liver surgery versus conventional treatment in terms of morbidity and mortality in the immediate postoperative period and until day 90, length of hospital stay, blood loss and the delay to bowel mobility recovery. Compliance to the program in both groups will also be evaluated.
Interventions
OTHERConventional care
OTHEREnhanced recovery
Sponsors
University Hospital, Angers
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patient to be operated on for hepatectomy in Universitary Hospital of Angers * No emergency surgery * No bilio-digestive anastomosis * Body Mass Index between 18 and 40 kg/m2 * Preoperative morbidity status graded with the American Society of Anesthesiologists (ASA) between I to III * Affiliated to the national health insurance
Exclusion criteria
* Pregnant woman * Patient who doesn't speack french * Colorectal surgery combined * Postoperative stay predictable in critical care unit * Patient under law protection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Day number to functional recovery | 90 days | The evaluation of time to functional recovery is scored once a day. A patient is fully functionally recovered when all of the following criteria are satisfied: 1. adequate pain control with oral analgesia: Post-operative pain is rated by the numeric rating scale. Nurses ask patients the intensity of their current pain on a scale of 0 (no pain) to 10 (worst possible pain). To satisfy this criterion, patient must rate their pain between 0 to 3 with only oral analgesics. 2. restoration of mobility to an independent level We decided to use the Groningen Activity Restriction Scale for rated the difference between preoperative and postoperative mobility level. To satisfy this criterion, patient must have the same score in postoperative. 3. absence of intravenous fluid administration for at least 24 hours. 4. ability to eat solid foods well tolerated for at least 24 hours to satisfy this criterion. 5. normal or decreasing serum bilirubin level and international normalised ratio. |
Countries
France
Contacts
Primary ContactEmilie Lermite, MD-PhD
Backup ContactJulien Barbieux, MD
Outcome results
None listed