Practical Application of ERAS Protocols in Older Adults with Hepatocellular Carcinoma Undergoing Hepatectomy: A Propensity Score Matching Study.

INTRODUCTION

This retrospective observational study aimed to evaluate the safety and efficacy of Enhanced Recovery After Surgery (ERAS) protocols in older adult patients (≥65 years) with hepatocellular carcinoma (HCC) undergoing radical hepatectomy.

METHODS

In this retrospective observational study, 498 patients who underwent radical resection for HCC between January 2018 and December 2023 were included and divided into four groups: Older adult ERAS (OE Group, n=60), Younger adult ERAS (YE Group, n=148), Older adult non-ERAS (ONE Group, n=88), and Younger adult non-ERAS (YNE Group, n=202). Propensity score matching (PSM) was performed to balance baseline covariates, generating three pairwise matched cohorts: PSM-OE Group 1 vs PSM-YE Group (both n=37), PSM-OE Group 2 vs PSM-ONE Group (both n=53), and PSM-OE Group 3 vs PSM-YNE Group (both n=35). Short-term postoperative outcomes were compared across groups.

RESULTS

Results showed that postoperative pain control was significantly superior in PSM-OE Group 1 compared to PSM-YE Group (91.9% vs 70.3% pain-free, p=0.018) and in PSM-OE Group 2 compared to PSM-ONE Group (90.6% vs 69.8% pain-free, 7.328, p=0.013), with no significant difference between PSM-OE Group 3 and PSM-YNE Group (85.7% vs 74.3%, p=0.319). PSM-OE Group 2 had significantly shorter length of hospital stays (LOS: 13.17±4.71 vs 16.68±6.42 days, p=0.002) and length of postoperative stays (LPS: 6.94±3.26 vs 9.64±5.02 days, p=0.001) than PSM-ONE Group, while PSM-OE Group 3 also showed shorter LOS (13.31±4.74 vs 17.34±9.75 days, p=0.031) and LPS (7.26±3.53 vs 10.49±6.58 days, p=0.013) compared to PSM-YNE Group. The complication rate was notably lower in PSM-OE Group 2 than PSM-ONE Group (χ2=13.747, p=0.001), with no significant differences in complication rates between other matched pairs. Blood transfusion rates, average hospitalization costs, liver reserve function (assessed by PALBI score), and 30-day readmission rates (p=0.700) showed no significant differences across all matched cohorts. Multivariate regression analysis confirmed ERAS as an independent factor associated with reduced LOS (OR=1.733, p=0.038), LPS (OR=1.901, p=0.015), postoperative pain (OR=5.014, p=0.035), and complications (OR=5.235, p=0.021).

CONCLUSION

ERAS protocols are safe and effective in enhancing postoperative recovery for older adult patients with HCC undergoing hepatectomy, supporting their adoption as standard perioperative care for this population.