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European Journal of Trauma and Emergency Surgery

20-11-2023 | Basic Surgery | Review Article

Enhanced recovery after surgery protocols following emergency intra-abdominal surgery: a systematic review and meta-analysis

Authors: Tyler McKechnie, Léa Tessier, Victoria Archer, Lily Park, Dan Cohen, Brendan Levac, Sameer Parpia, Mohit Bhandari, Joanna Dionne, Cagla Eskicioglu

Published in: European Journal of Trauma and Emergency Surgery

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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.
Appendix
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Metadata
Title
Enhanced recovery after surgery protocols following emergency intra-abdominal surgery: a systematic review and meta-analysis
Authors
Tyler McKechnie
Léa Tessier
Victoria Archer
Lily Park
Dan Cohen
Brendan Levac
Sameer Parpia
Mohit Bhandari
Joanna Dionne
Cagla Eskicioglu
Publication date
20-11-2023
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-023-02387-6