Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature

Offodile, Anaeze C.; Gu, Cindy; Boukovalas, Stefanos; Coroneos, Christopher J.; Chatterjee, Abhishek; Largo, René D.; Butler, Charles E.

doi:10.1007/s10549-018-4991-8

Cited by 149 publications

(147 citation statements)

References 37 publications

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“…However, Gnaneswaran et al (11) only included three studies, an inadequate number, and only four outcome measures, which was insufficient to assess the safety and effectiveness of the ERAS program for breast reconstruction surgery. Offodile et al (13) included six observational studies, three-fifths the number of studies our review included. Moreover, Offodile et al (13) did not report the implementation of ERAS elements in standard perioperative care program; however, it cannot be ignored that it will definitely weaken the effect of the ERAS program in patients undergoing breast reconstruction surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Another study of microsurgical breast reconstruction published in 2017 was the minutes taken during a meeting (12). The third study, published in 2018, included nine systematic reviews and meta-analyses of breast reconstructions (13). Therefore, here we included more studies to confirm our results through detailed systematic reviews and meta-analyses.…”

Section: Introductionmentioning

confidence: 99%

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Enhanced Recovery After Surgery for Breast Reconstruction: Pooled Meta-Analysis of 10 Observational Studies Involving 1,838 Patients

Tan

Luo

et al. 2019

Front. Oncol.

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Purpose: This study aims to explore the effectiveness and safety of the enhanced recovery after surgery (ERAS) protocol vs. traditional perioperative care programs for breast reconstruction. Methods: Three electronic databases (PubMed, EMBASE, and Cochrane Library) were searched for observational studies comparing an ERAS program with a traditional perioperative care program from database inception to 5 May 2018. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated study quality using the Newcastle-Ottawa Scale. Subgroup and sensitivity analyses were performed. The outcomes included the length of hospital stay (LOS), complication rates, pain control, costs, emergency department visits, hospital readmission, and unplanned reoperation. Results: Ten studies were included in the meta-analysis. Compared with a conventional program, ERAS was associated with significantly decreased LOS, morphine administration (including postoperative patient-controlled analgesia usage rate and duration; intravenous morphine administration on postoperative day [POD] 0, 1, 2, and 4; total intravenous morphine administration on POD 0–3; oral morphine consumption on POD 0–4; and total postoperative oral morphine consumption), and pain scores (postoperative pain score on POD 0 and total pain score on POD 0–3). The other variables did not differ significantly. Conclusion: Our results suggest that ERAS protocols can decrease LOS and morphine equivalent dosing; therefore, further larger, and better-quality studies that report on bleeding amount and patient satisfaction are needed to validate our findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery After Surgery for Breast Reconstruction: Pooled Meta-Analysis of 10 Observational Studies Involving 1,838 Patients

Tan

Luo

et al. 2019

Front. Oncol.

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“…Although the evidence for ERAS application in esophageal surgery is limited, ERAS has been proven to be beneficial regarding short and long term outcomes in other disciplines of surgery, confirming its versatility (51,52). ERAS was found to be safe in gastric cancer surgery, improving short term outcomes without increasing morbidity (53,54).…”

Section: Rationale For Eras Introductionmentioning

confidence: 95%

Enhanced recovery after surgery (ERAS) programs for esophagectomy

Rubinkiewicz¹,

Witowski²,

Su³

et al. 2019

J. Thorac. Dis

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A perioperative treatment protocol, enhanced recovery after surgery (ERAS) focuses on accelerating patient recovery. Previous studies confirmed that ERAS decreases surgical trauma and the stress response, which improved outcomes including reduced length of hospital stay (LOS) and decreased postoperative morbidity. While ERAS protocols have been successfully implemented in a variety of surgical disciplines (colorectal, bariatric, orthopedic, and gynecologic surgery), its use in esophageal surgery is still limited. This paper analyzes the feasibility and value of the ERAS protocol for esophageal surgery. Reviewing the literature found that implementation of ERAS resulted in decreased costs, length of stay and pulmonary specific complication reduction, but not overall morbidity. The evidence lacks randomized control trials. Further, the ERAS Society published recommendations for esophageal resection. This opportunity for unification of the protocol would make the studies more comparable and leads to stronger conclusions. Surgery specific items also require further confirmation. Nonetheless, the successful introduction of the ERAS protocol into a wide variety of surgical disciplines provides optimism for ERAS's effectiveness in esophageal surgery.

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“…And the reduction of LOS were 3.75 days (−5.13 to −2.36) in cystectomy; [ 64 ] 3.55 days (−4.42 to −2.69) in esophageal cancer surgery; [ 69 ] 3.5 days (−5.8 to −1.4) in vascular operations; [ 79 ] 3.17 days (−3.99 to −2.35) in liver surgery; [ 49 ] 3.05 days (−4.87 to −1.23) in abdominal gynecologic surgery, [ 74 ] and 1.58 days (−1.99 to −1.18) in breast reconstruction. [ 66 ] There are also some articles shown the reduction of PLOS, in pancreatic surgery, it was shorter 4.45 days (−5.99 to −2.91) [ 72 ] than traditional groups, 4.17 days (−5.72 to −2.61) in pancreaticoduodenectomy [ 73 ] and 2.72 days (−3.86 to −1.57) in hepatectomy. [ 44 ] Meta-analysis shown a significant reduction in the total cost of hospital for upper gastrointestinal surgery, [ 81 ] liver surgery [ 47 ] and non-colorectal surgery [ 82 ] compared with control groups.…”

Section: Resultsmentioning

confidence: 99%