Enhanced Recovery after Surgery (ERAS) in Major Hepatopancreaticobiliary Surgery: A Prospective Institutional Cohort Demonstrating Reduced Morbidity and Accelerated Recovery

Abstract

Objective: To evaluate the feasibility, safety, and clinical outcomes of implementing an Enhanced Recovery After Surgery (ERAS) protocol in major hepatopancreaticobiliary (HPB) surgery.

Study Design: Prospective Observational Cohort study.

Study Setting: This study was conducted at the Department of HBP and Liver Transplant, Bahria International Hospital, Orchard Lahore

Study Duration: from December’23 to May‘25).

Methodology: A total of 280 consecutive adult patients undergoing living donor hepatectomy, therapeutic liver resection, or pancreaticoduodenectomy were analyzed following ERAS implementation at a tertiary referral center. Primary outcomes were length of hospital stay (LOS) and postoperative morbidity. Secondary outcomes included 30-day readmission, reoperation, and mortality.

Results: A total of 280 patients underwent major hepatopancreaticobiliary surgery under an ERAS protocol. The mean length of hospital stay was 5 days (range: 3–10 days), with 78.6% of patients discharged on postoperative day 5 (p < 0.001 compared to conventional benchmarks). The overall postoperative complication rate was 6.8% (95% CI: 4.2%–10.2%), which is significantly lower than reported rates in standard care (p < 0.001). Re-exploration was required in 1.8% of patients (95% CI: 0.6%–4.1%, p = 0.014), while the readmission rate was 2.5% (95% CI: 1.0%–5.1%, p < 0.001). There was no 30-day mortality, with an upper 95% confidence limit of 1.1%. Conclusion: Implementation of ERAS in major HPB surgery is feasible and safe and is associated with accelerated discharge without increased morbidity or mortality. These findings support broader adoption of ERAS protocols in complex HPB surgical practice.