Effectiveness of Enhanced Recovery After Surgery protocol in pancreatic surgery: a systematic review and meta-analysis of randomized controlled trials

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastrointestinal Surgery Pub Date : 2025-01-02 DOI:10.1016/j.gassur.2024.101939

Maurício Prätzel Ellwanger , Manuela Pozza Ellwanger , Matheus Budahazi Jardine , Victoria Bramucci , Stephany Aparecida Pereira Hammes , Lucca Moreira Lopes , Antônio Carlos Mattar Munhoz

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Abstract

Background

The Enhanced Recovery After Surgery (ERAS) protocol represents an advancement in perioperative care to reduce surgical stress and accelerate recovery. This meta-analysis aimed to evaluate the effectiveness of ERAS in pancreatic surgery and to assess the effect of the ERAS protocol vs conventional hospital care on postoperative outcomes, including length of stay (LOS) in the hospital, hospital costs, readmission rates, and infection rates in patients undergoing pancreatic surgery.

Methods

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant RCTs. Data were extracted and analyzed using a random effects model. Statistical analyses were performed using RStudio.

Results

A total of 7 RCTs involving 731 patients were included. The meta-analysis showed a statistically significant reduction in LOS by 2.49 days (mean difference, −2.49; 95% CI, −4.20 to −0.79; P <.01) with considerable heterogeneity (I² = 86%). Hospital costs were significantly reduced (standardized mean difference, −0.36; 95% CI, −0.65 to −0.06; P =.02) with moderate heterogeneity (I² = 52%). The readmission and infection rates showed no statistically significant differences between the ERAS and control groups. The Egger test indicated no significant publication bias.

Conclusion

The ERAS protocol significantly reduced LOS and hospital costs in patients who underwent pancreatic surgery. Our findings support the implementation of ERAS protocols to enhance recovery and optimize outcomes. To the best of our knowledge, our study is the first to demonstrate these results using an RCT-only meta-analysis approach in pancreatic surgery, highlighting the value of ERAS in improving perioperative care.

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胰腺手术后增强恢复（ERAS）方案的有效性-随机对照试验的系统回顾和荟萃分析。

简介：手术后增强恢复（ERAS）协议代表了围手术期护理的进步，以减少手术压力和加速恢复。本荟萃分析评估了ERAS在胰腺手术中的有效性。目的：评估ERAS方案与传统医院护理相比对胰腺手术患者术后结局的影响，包括住院时间（LOS）、住院费用、再入院率和感染率。方法：对遵循PRISMA指南的随机对照试验（rct）进行系统评价和荟萃分析。我们检索了PubMed、Cochrane Central Register of Controlled Trials和Embase以确定相关的随机对照试验。数据提取和分析使用随机效应模型。使用RStudio进行统计分析。结果：纳入7项随机对照试验，共731例患者。荟萃分析显示，LOS减少了2.49天，具有统计学意义(MD = -2.49；95% ci [-4.20；-0.79);p < 0.01)，异质性显著（I2 = 86%）。住院费用显著降低(SMD = -0.36；95% ci [-0.65；-0.06);p = 0.02)，异质性中等（I2 = 52%）。ERAS组与对照组再入院率和感染率无统计学差异。Egger检验未发现显著的发表偏倚。结论：ERAS方案可显著降低胰腺手术患者的LOS和住院费用。这些发现支持ERAS方案的实施，以提高采收率和优化结果。我们的研究首次在胰腺手术中使用rct荟萃分析方法证明了这些结果，强调了ERAS在改善围手术期护理方面的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Surgery 医学-外科

CiteScore

5.50

自引率

3.10%

发文量

319

审稿时长

2 months

期刊介绍： The Journal of Gastrointestinal Surgery is a scholarly, peer-reviewed journal that updates the surgeon on the latest developments in gastrointestinal surgery. The journal includes original articles on surgery of the digestive tract; gastrointestinal images; "How I Do It" articles, subject reviews, book reports, editorial columns, the SSAT Presidential Address, articles by a guest orator, symposia, letters, results of conferences and more. This is the official publication of the Society for Surgery of the Alimentary Tract. The journal functions as an outstanding forum for continuing education in surgery and diseases of the gastrointestinal tract.

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