score / Level evidence / Studied
items / Morbidity / LOS
Pirlich / 2006 / Prospective / NA / 3 / Perioperative nutrition / Not assessed / Decreased
ESPEN guidelines / 2006 / Expert opinion / NA / 5 / Perioperative nutrition / Patients having lost more than 10% of their body weight should postpone surgery and benefit from dedicated nutritional therapy for at least 2 weeks. For the remaining 5-7 days of oral supplements before surgery reduce morbidity. / Decreased
Bilku / 2014 / Systematic review of RCTs / NA / 2 / Preoperative fasting and treatment with carbohydrates / No difference / No difference
Lassen / 2008 / RCT / 6 / 1 / Postoperative artificial nutrition / No difference / No difference
Richter / 2006 / Systematic review of RCTs / NA / 2 / Postoperative artificial nutrition / Enteral nutrition reduced wound infection and catheter-related complications / Not assessed
Melloul / 2012 / Prospective / NA / 3 / Anti-thrombotic prophylaxis / Thromboprophylaxis indicated particularly in patients with high BMI, normal liver parenchyma and major resection / Not assessed
Reddy / 2011 / Retro with co / NA / 3 / Anti-thrombotic prophylaxis / Postoperative thromboprophylaxis reduce the incidence of venous thromboembolism events / Not assessed
Gurusamy (Cochrane) / 2011 / Metaanalysis / NA / 1 / Antimicrobial prophylaxis / No antimicrobial method improved outcome / Not assessed
Darouiche / 2010 / RCT / 4 / 1 / Skin preparation / Preoperative cleansing with chlorhexidine is superior to povidone iodine for preventing SSI / Not asssessed
D'Angelica / 2006 / Retro with co / NA / 3 / Incision (Extended right subcostal vs. Mercedes) / Extended right subcostal associated with fewer wound complications compared to Mercedes incision / No difference
Togo / 2008 / Retro with co / NA / 3 / Incision (median vs. J-shaped vs.subcostal vs. Mercedes) / More incisional hernia after Mercedes incision / Not assessed
Simillis / 2007 / Meta-analysis (non randomized trials) / NA / 3 / Minimal invasive approach (laparoscopic vs. open) / Laproscopic approach results in reduced operative blood loss and earlier recovery / Decreased
Croome / 2010 / Meta-analysis (non randomized trials) / NA / 3 / Minimal invasive approach (laparoscopic vs. open) / Lower operative blood loss and lower complications after laparoscopy / Decreased
Mitzuguchi / 2011 / Meta-analysis (non randomized trials) / NA / 3 / Minimal invasive approach (laparoscopic vs. open) / Lower operative blood loss and lower complications after laparoscopy / Decreased
Zhou / 2011 / Meta-analysis (non randomized trials) / NA / 3 / Minimal invasive approach (laparoscopic vs. open) / Lower operative blood loss and lower complications after laparoscopy / Decreased
Mirnezami / 2011 / Meta-analysis (non randomized trials) / NA / 3 / Minimal invasive approach (laparoscopic vs. open) / Lower operative blood loss, ileus and complications after laparoscopy / Decreased
Fancellu / 2011 / Meta-analysis (non randomized trials) / NA / 3 / Minimal invasive approach (laparoscopic vs. open) / Lower operative blood loss and lower complications after laparoscopy / Decreased
Xiong / 2012 / Meta-analysis (non randomized trials) / NA / 3 / Minimal invasive approach (laparoscopic vs. open) / Lower operative blood loss, ascites and complications after laparoscopy / Decreased
Yin / 2013 / Meta-analysis (non randomized trials) / NA / 3 / Minimal invasive approach (laparoscopic vs. open) / Lower operative blood loss and lower complications after laparoscopy / Decreased
Richardson / 2012 / Meta-analysis / NA / 2 / Peri-operative steroids administration / Trend towards lower post-operative complications / Not assessed
Hayashi / 2011 / RCT / 7 / 1 / Peri-operative steroids administration / Positive impact on liver function. No difference in complications / No difference
Lehtinen / 2010 / Case-control (33% Hepatobiliary cases) / NA / 3 / Normothermia to prevent Surgical site infection (SSI) / No association between normothermia and SSI / Not assessed
Wong / 2007 / RCT (mixture of abdominal surgery cases) / 5 / 2 / Preventing intraoperative hypothermia / Perioperative warming reduce blood loss and complications / No difference
Okabayashi / 2009 / RCT / 3 / 2 / Postoperative glycaemic control / Intensive insulin therapy using a closed loop system lower SSI / Decreased
Pessaux / 2007 / RCT / 5 / 2 / Prophylactic Nasogastric intubation (NGT) / NGT has no advantage. NGT increased the risk of pulmonary complications / No difference
Petrowsky / 2004 / Meta-analysis (only 3 RCTs on liver surgery included) / NA / 3 / Prophylactic abdominal drainage / Drains should be omitted after hepatic surgery / Decreased with no drainage
Igami / 2011 / RCT / 4 / 2 / Prevention of delayed gastric emptying (DGE) / DGE reduced with omental flap on the cut surface after left sided hepatectomy / Not assessed
Yoshida / 2005 / RCT / 3 / 2 / Prevention of delayed gastric emptying (DGE) / DGE reduced with omental flap on the cut surface after left sided hepatectomy / Not assessed
Hendry / 2010 / RCT / 2 / 2 / Use of postoperative laxatives / Earlier passage of first stool, no change in morbidity / Decreased
Short (Cochrane) / 2015 / Meta-analysis / NA / 1 / Chewing gum / No difference / Not assessed
Ivers (Cochrane) / 2012 / Meta-analysis / NA / 1 / Audit / Audit provides improvements in professional practice / Not assessed
Kasivisvanathan / 2014 / Prospective observational / NA / 4 / Epidural vs. intrathecal morphine and fentanyl PCA analgesia / Lower blood loss with Epidural Time to mobilization, fluid requirements increased in epidural analgesia / Lower after intrathecal morphine and fentanyl PCA
Bell / 2014 / Meta-analysis / NA / 2 / Analgesia by wound catheters vs. Epidurals / Overall complications higher with Epidurals / No difference
Gurusamy (Cochrane) / 2009 / Meta-analysis / NA / 2 / Fluid management / lowering CVP during hepatectomy decreases blood loss, but no difference in morbidity compared to controls / Not assessed
Hughes / 2015 / Meta-analysis / NA / 2 / Low central venous pressure control / lowering CVP during hepatectomy decreases blood loss / Not assessed
Jones / 2013 / RCT / 7 / 1 / Goal directed fluid therapy / Decreased / Decreased
McCluskey / 2013 / Propensity matched cohort study / NA / 2 / Fluid management / Balanced Crystalloids solutions avoids hyperchloraemic acidosis and reduced morbidity compared to saline 0.9% solutions / Not assessed
LOS length of hospital stay