ABSTRACT
INTRODUCTION: Enhanced recovery protocols (ERP) accelerate recovery and shorten postoperative hospital stay. This increased knowledge of ERPs has also gradually implemented into liver surgery. However, in laparoscopic liver surgery (LLS), the experience of optimized perioperative care protocols is still limited. METHODS: We prospectively studied the implementation of multimodal ERP principles to LLS in the first 100 consecutive patients. Opioid-sparing multimodal pain management was applied together with early mobilization already in the postoperative care unit (PACU). Drains and catheters were avoided and per oral intake was initiated promptly. Primary pain control was achieved with iv NSAIDS, low-dose opioid and corticosteroids. Combination of per oral ibuprofen and long-acting tramadol was routinely administered shortly after operation. The multiprofessional adherence to the protocol was also evaluated. RESULTS: Investigated LLS was performed during Aug 2016-Apr 2019. Operations were done due to malignancy in 83 (83%) of cases, mostly for colorectal liver metastases (n = 52, 52%). Forty-eight (48%) of the operated patients were female. Median age was 65 years (range 17-91). The American Society of Anaesthesiologists Physical Status (ASA) classification median was three. Median postoperative hospital stay was 2 days (range 1-8 days). More than seventy percent of patients were discharged by the second postoperative day and nearly ninety percent by the third postoperative day. Complications after surgery were few. The new ERP elements were adopted in most of the cases. CONCLUSIONS: ERP was introduced safely and effectively after LLS. The adherence to the ERP was good. Routine discharge 1-2 days after LLS is realistic and achievable.
Subject(s)
Enhanced Recovery After Surgery , Laparoscopy , Liver/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Laparoscopy/adverse effects , Length of Stay , Liver Neoplasms/surgery , Male , Middle Aged , Pain Management , Pain, Postoperative/etiology , Patient Compliance , Patient Discharge , Patient Satisfaction , Retrospective Studies , Young AdultABSTRACT
Advantages of digitalization are understood, but implementation to healthcare is slow. Cost savings and quality improvements are needed in healthcare. Continuous education of healthcare professionals is essential for quality, and digital education (DE) enables that cost-efficiently. The aim was to evaluate the cost-effectiveness of a DE for wound care by comparing it to lecture education (LE). DE enabled a slightly better learning outcome than LE. However, combination resulted in superior outcome. DE provided best cost-effectiveness.