Effect of Enhanced Recovery After Surgery (ERAS) Programs on Perioperative Outcomes in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis

Abstract

Background

Enhanced recovery after surgery (ERAS) programs emerged as a strategy to reduce perioperative morbidity; however, there is currently limited evidence of their clinical efficacy. The objective of this study was to assess the impact of ERAS programs in cardiac surgery on hospital length of stay, mortality, atrial fibrillation, and quality of life.

Methods

A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, encompassing studies on ERAS programs in adult patients undergoing elective cardiac surgery. The effect size and 95% confidence interval (CI) were estimated with a random-effects model. The protocol was preregistered on Open Science Framework.

Results

Eighteen studies (published between 2016 and 2023) comprising 4,469 patients were included in the analysis, of which only one was a randomized controlled trial. The implementation of ERAS was associated with a reduction in hospital stay of 1.24 days (95% CI: –1.67, –0.82, p < 0.001, I² = 83%). No differences were observed between the groups in mortality (odds ratio: 0.65, 95% CI: 0.28, 1.48, p = 0.3, I² = 0%), nor in the incidence of atrial fibrillation (odds ratio: 0.77, 95% CI: 0.57, 1.03, p = 0.08, I² = 17%). A meta-analysis of quality of life was not feasible due to a lack of sufficient data.

Conclusions

Although ERAS programs were associated with a reduction in hospital stay and no differences in mortality or atrial fibrillation, the quality of the evidence was very low. To recommend the implementation of ERAS programs in cardiac surgery, it is necessary to have randomized studies providing evidence of its efficacy, and studies including quality of life and other patient-centered recovery criteria outcomes.