Recommendations for Perioperative Care in Liver Resection: The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol
Abstract
1. Introduction
2. The EUPEMEN Initiative
3. The EUPEMEN Protocol in Liver Surgery
3.1. Before Admission
3.2. Perioperative Phase
3.2.1. Immediate Preoperative
3.2.2. Intraoperative Phase
3.2.3. Immediate Postoperative Phase
3.3. Postoperative Day 1 and 2 (Ward)
3.4. Discharge
4. Discussion
5. Enhanced Recovery After Surgery (ERAS) for Liver Resections
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
EUPEMEN | European Perioperative Medical Networking |
ERAS | Enhanced Recovery After Surgery |
Via RICA | Via Clinica de Recuperacion Intensificada en Cirugia Del Adulto |
MUST | Malnutrition Universal Screening Tool |
PONV | Postoperative Nausea and Vomiting |
ASA | American Society of Anesthesiologists |
LMWH | Low Molecular Weight Heparin |
SSIs | Surgical Site Infections |
WHO | World Health Organization |
RSI | Rapid Sequence Induction |
FiO2 | Fraction of Inspired Oxygen |
EtCO2 | End-tidal carbon dioxide |
GDT | Goal-directed fluid therapy |
VAS | Visual Analogue Scale |
LoS | Length of Stay |
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Aspect | Standard ERAS Protocol | EUPEMEN Protocol |
---|---|---|
Scope of Application | Global recommendations, generalized pathways | European-focused, procedure-specific adaptation |
Development Process | Expert consensus by international societies | Multidisciplinary European network, consensus + clinical input |
Procedure Specificity | General principles, adaptable | Highly detailed, procedure-specific protocols (e.g., liver, gastric, appendicitis) |
Implementation Tools | Guidelines and clinical pathways | Online platform, multilingual manuals, train-the-trainer, audits |
Target Audience | Surgeons, anesthetists, perioperative teams | Full multidisciplinary teams, incl. dietitians, nurses, primary care |
Barriers Addressed | Limited guidance on barriers | Cultural, organizational, and resource barriers actively addressed |
Monitoring and Sustainability | Variable adherence, limited audits | Embedded auditing and continuous improvement processes |
Patient Engagement | Emphasized but center-dependent | Standardized counseling, shared decision-making, informed consent |
Aim | Enhance recovery and reduce hospital stay | Harmonize European care, improve outcomes, reduce costs |
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© 2025 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Ioannidis, O.; Koltsida, A.; Anestiadou, E.; Ramirez, J.M.; Fabbri, N.; Ubieto, J.M.; Feo, C.V.; Pesce, A.; Rosetzka, K.; Arroyo, A.; et al. Recommendations for Perioperative Care in Liver Resection: The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol. Medicina 2025, 61, 978. https://doi.org/10.3390/medicina61060978
Ioannidis O, Koltsida A, Anestiadou E, Ramirez JM, Fabbri N, Ubieto JM, Feo CV, Pesce A, Rosetzka K, Arroyo A, et al. Recommendations for Perioperative Care in Liver Resection: The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol. Medicina. 2025; 61(6):978. https://doi.org/10.3390/medicina61060978
Chicago/Turabian StyleIoannidis, Orestis, Aggeliki Koltsida, Elissavet Anestiadou, Jose M. Ramirez, Nicolò Fabbri, Javier Martínez Ubieto, Carlo Vittorio Feo, Antonio Pesce, Kristyna Rosetzka, Antonio Arroyo, and et al. 2025. "Recommendations for Perioperative Care in Liver Resection: The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol" Medicina 61, no. 6: 978. https://doi.org/10.3390/medicina61060978
APA StyleIoannidis, O., Koltsida, A., Anestiadou, E., Ramirez, J. M., Fabbri, N., Ubieto, J. M., Feo, C. V., Pesce, A., Rosetzka, K., Arroyo, A., Kocián, P., Sánchez-Guillén, L., Bellosta, A. P., Whitley, A., Enguita, A. B., Teresa-Fernandéz, M., Bitsianis, S., & Symeonidis, S. (2025). Recommendations for Perioperative Care in Liver Resection: The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol. Medicina, 61(6), 978. https://doi.org/10.3390/medicina61060978