Enhanced Recovery After Surgery Protocols Following Emergency Intra-abdominal Surgery: a Systematic Review and Meta-analysis

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2023 Nov 20

PMID 37985500

Authors

Tyler McKechnie

Lea Tessier

Victoria Archer

Lily Park

Dan Cohen

Brendan Levac

Sameer Parpia

Mohit Bhandari

Joanna Dionne

Cagla Eskicioglu

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this systematic review and meta-analysis was to evaluate whether Enhanced Recovery After Surgery (ERAS) protocols for patients undergoing emergency intra-abdominal surgery improve postoperative outcomes as compared to conventional care.

Methods: MEDLINE, EMBASE, WoS, CENTRAL, and Pubmed were searched from inception to December 2022. Articles were eligible if they were randomized controlled trials (RCT) or non-randomized studies comparing ERAS protocols to conventional care for patients undergoing emergency intra-abdominal surgery. The outcomes included postoperative length of stay (LOS), postoperative morbidity, prolonged postoperative ileus (PPOI), and readmission. An inverse variance random effects meta-analysis was performed. A risk of bias was assessed with Cochrane tools. Certainty of evidence was assessed with GRADE.

Results: After screening 1018 citations, 20 studies with 1615 patients in ERAS programs and 1933 patients receiving conventional care were included. There was a reduction in postoperative LOS in the ERAS group for patients undergoing upper gastrointestinal (GI) surgery (MD3.35, 95% CI 2.52-4.17, p < 0.00001) and lower GI surgery (MD2.80, 95% CI 2.62-2.99, p < 0.00001). There was a reduction in postoperative morbidity in the ERAS group for patients undergoing upper GI surgery (RR0.56, 95% CI 0.30-1.02, p = 0.06) and lower GI surgery (RR 0.66, 95%CI 0.52-0.85, p = 0.001). In the upper and lower GI subgroup, there were nonsignificant reductions in PPOI in the ERAS groups (RR0.59, 95% CI 0.30-1.17, p = 0.13; RR0.49, 95% CI 0.21-1.14, p = 0.10). There was a nonsignificant increased risk of readmission in the ERAS group (RR1.60, 95% CI 0.57-4.50, p = 0.50).

Conclusion: There is low-to-very-low certainty evidence supporting the use ERAS protocols for patients undergoing emergency intra-abdominal surgery. The currently available data are limited by imprecision.

Citing Articles

Effects of oscillatory positive expiratory pressure therapy in patients undergoing thoracic or upper abdominal surgery: A systematic review and meta-analysis.

You J, Jiang B, Dai N, Lu B, Zhao C, Zheng Z Heliyon. 2024; 10(18):e37798.

PMID: 39315191 PMC: 11417579. DOI: 10.1016/j.heliyon.2024.e37798.

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