A team of European liver surgery experts reviewed hundreds of medical studies to create clear guidelines for helping patients recover safely after liver surgery. They focused on six major areas: preventing blood clots, using the right antibiotics, preparing patients before surgery, preventing bile leaks, stopping bleeding, and preventing liver failure. The experts found strong evidence for some practices (like getting patients moving early and eating well) but discovered gaps in knowledge for others. These guidelines aim to help doctors and hospitals provide the best possible care and reduce complications for people undergoing liver surgery.

The Quick Take

  • What they studied: What doctors should do before, during, and after liver surgery to keep patients safe and help them recover well
  • Who participated: The research team reviewed 204 published medical studies (out of 6,514 initially found) involving thousands of liver surgery patients across Europe. Expert doctors, nurses, and physical therapists worked together to analyze the evidence.
  • Key finding: The experts created 32 clear recommendations for liver surgery care. They found strong evidence that preparing patients beforehand, getting them moving early after surgery, and avoiding routine drainage tubes works best. However, they found weaker evidence for preventing blood clots and liver failure after surgery.
  • What it means for you: If you’re having liver surgery, ask your hospital if they follow these guidelines. The strongest recommendations—preparing your body before surgery, moving around soon after, and eating well—appear to give the best results. Talk to your surgical team about which practices they use.

The Research Details

This wasn’t a single experiment but rather a careful review of hundreds of existing studies. Experts from multiple European countries (surgeons, anesthesiologists, liver specialists, nurses, and physical therapists) worked together using a structured process called a ‘modified Delphi method.’ They searched four major medical databases for all published research on liver surgery recovery, then evaluated the quality of each study using strict scientific standards. The team discussed the evidence until at least 70% agreed on each recommendation.

The researchers looked at six specific areas of care: preventing blood clots, choosing antibiotics, preparing patients and helping them move and eat well, preventing bile leaks, stopping bleeding, and preventing liver failure. For each topic, they assessed how strong the scientific evidence was—ranging from weak evidence (based on small studies or expert opinion) to very strong evidence (based on large, well-designed trials).

This approach is like having a panel of the world’s best liver surgery experts review all the scientific evidence and agree on what actually works best. It’s more reliable than any single study because it combines knowledge from hundreds of research projects.

Liver surgery is one of the most complex operations doctors perform because the liver is crucial for survival and has many important functions. Complications after liver surgery can be serious and life-threatening. By reviewing all available evidence and creating clear guidelines, hospitals can standardize their care and reduce complications. This helps ensure that whether you have surgery in one country or another, you’ll receive evidence-based care.

This review is highly credible because it was conducted by leading European liver surgery experts and published in a respected medical journal. The team used rigorous scientific methods to evaluate studies, similar to how courts evaluate evidence. However, readers should know that the strength of evidence varied by topic—some recommendations are based on many large studies, while others are based on smaller or fewer studies. The experts identified several areas where more research is needed, particularly for blood clot prevention and liver failure management.

What the Results Show

The expert panel created 32 specific recommendations for liver surgery care. The strongest recommendations—those with the most scientific support—focused on three areas: preparing patients before surgery (called prehabilitation), getting patients to move and exercise early after surgery, and avoiding routine use of drainage tubes after surgery. These practices appear to reduce complications and help patients recover faster.

For preventing blood clots, the experts found the evidence was weaker than expected, meaning doctors still disagree somewhat on the best approach. Similarly, preventing liver failure after surgery had limited strong evidence, though the experts provided guidance based on the best available information.

The team found strong evidence supporting the use of antibiotics to prevent infection, though the specific type and timing matter. For preventing bile leaks (a serious complication where digestive fluid escapes), the evidence was moderate, and recommendations varied depending on the type of surgery performed.

Overall, the recommendations emphasize that good perioperative care (before, during, and after surgery) requires a team approach involving surgeons, anesthesiologists, nurses, and other specialists working together.

Beyond the main six topics, the review highlighted the importance of individualized care based on patient factors like age, liver disease severity, and overall health. The experts noted that some recommendations that work well for routine liver surgery may need adjustment for more complex cases. They also emphasized the value of nutrition support and early mobilization (getting patients moving) as key factors in recovery. The review identified that hospital protocols and standardized care pathways can significantly improve outcomes.

This consensus represents an update and consolidation of previous guidance on liver surgery care. It incorporates recent research published since earlier guidelines and provides more detailed recommendations for specific complications. The emphasis on prehabilitation and early mobilization reflects a shift in modern surgery toward preparing patients before surgery and activating them quickly afterward, rather than keeping them in bed for long periods. This aligns with similar trends in other types of major surgery.

The main limitation is that evidence quality varied significantly across topics. Some recommendations are based on many high-quality studies, while others rely on smaller studies or expert consensus. The review couldn’t include all possible variations of liver surgery or all patient populations, so some recommendations may not apply equally to everyone. Additionally, the experts noted that future multicentre studies (involving many hospitals) are needed to fill evidence gaps, particularly for blood clot prevention and liver failure management. The recommendations are based primarily on European practices and may need adaptation in other healthcare systems.

The Bottom Line

If you’re having liver surgery: (1) Work with your surgical team on prehabilitation—preparing your body through nutrition, exercise, and mental preparation before surgery (Strong recommendation). (2) Plan to start moving and exercising as soon as possible after surgery, as tolerated (Strong recommendation). (3) Ensure your surgical team uses appropriate antibiotics to prevent infection (Strong recommendation). (4) Discuss with your team whether drainage tubes are necessary for your specific surgery, as routine use isn’t recommended (Strong recommendation). (5) Ask about blood clot prevention measures, as evidence here is less clear (Conditional recommendation). These recommendations should be personalized to your specific situation and health status.

These guidelines are most relevant for people scheduled for liver surgery and their families, as well as hospitals and surgical teams. Patients with liver disease, cancer, or other conditions requiring liver surgery should discuss these recommendations with their surgical team. The guidelines may be less applicable to emergency liver surgery situations where preparation time is limited. People with specific medical conditions or taking certain medications should discuss how these recommendations apply to their individual case.

Benefits from prehabilitation (pre-surgery preparation) may appear within weeks of starting, with improved strength and endurance before surgery. After surgery, early mobilization can reduce complications within the first few days to weeks. Full recovery typically takes 4-8 weeks for straightforward liver surgery, though more complex cases may take longer. Reduced complication rates from following these guidelines should be evident within the first month after surgery, though some benefits (like improved long-term liver function) may take several months to fully appear.

Want to Apply This Research?

  • Track daily steps and movement minutes starting 2-3 weeks before surgery and continuing through recovery. Set a goal of gradually increasing activity (e.g., 500 steps daily pre-surgery, increasing to 3,000+ steps daily by week 2 post-surgery). Log any complications or concerns (pain, swelling, fever) to share with your surgical team.
  • Use the app to schedule and track prehabilitation activities: nutrition goals (protein intake, calorie targets), exercise routines (walking, light stretching), and mental preparation (meditation, stress reduction). Post-surgery, use it to log daily mobilization—time spent walking, sitting up, and light activities—with reminders to gradually increase activity as approved by your surgical team.
  • Create a pre-surgery baseline of your fitness and nutrition status. Post-surgery, track recovery milestones weekly: wound healing, pain levels, activity tolerance, and return to normal diet. Set alerts for concerning symptoms (fever, excessive drainage, severe pain) that warrant contacting your surgical team. Use the app to prepare for follow-up appointments by documenting your recovery progress.

This summary is for educational purposes and should not replace professional medical advice. Liver surgery is a complex procedure with individual variations. The recommendations in this article are general guidelines and may not apply to your specific situation. Always consult with your surgical team, hepatologist, and other healthcare providers about your individual care plan. If you experience symptoms like fever, severe pain, excessive bleeding, or difficulty breathing after liver surgery, seek immediate medical attention. These guidelines represent current expert consensus but medical knowledge evolves, and your doctors may recommend different approaches based on your unique circumstances.