Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Noba, Lyrics; Rodgers, Sheila; Chandler, Colin; Balfour, Angie; Hariharan, Deepak; Yip, Vincent

doi:10.1007/s11605-019-04499-0

Cited by 144 publications

(130 citation statements)

References 43 publications

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“…The analysis results of other secondary outcome measures showed that patients with ERAS protocol had shorter postoperative hospital stay, and there was no statistical difference in 30-day readmission rate, reoperation rate and mortality compared with standard care, indicating that patients with ERAS had faster postoperative recovery and better. A large number of previous studies have shown that ERAS regimen reduces the incidence of common postoperative complications, accelerates the early recovery of intestinal function, accelerates the early postoperative mobilization of patients and reduces the cost of hospitalization [6,[55][56][57][58]. Obviously, ERAS protocol has many advantages compared with the standard care, and according to our study ERAS protocol has no significant impact on the incidence of postoperative AKI, affirming the safety of ERAS protocol on renal function, which is conducive to the further development of ERAS protocol.…”

Section: Plos Onementioning

confidence: 99%

Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

Shen

Wang

et al. 2021

PLoS ONE

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Background Acute kidney injury (AKI) is a common postoperative complication with an incidence of nearly 15%. Relatively balanced fluid management, flexible use of vasoactive drugs, multimodal analgesia containing non-steroidal anti-inflammatory drugs are fundamental to ERAS protocols. However, these basic tenants may lead to an increased incidence of postoperative AKI. Methods A search was done in the PubMed, Embase, Cochrane Library and reference lists to identify relevant studies from inception until May 2020 to be included in this study. Effects were summarized using pooled risk ratios (RRs), mean differences (MDs) and corresponding 95% confidence intervals (Cls) with random effect model. Heterogeneity assessment, sensitivity analysis, and publication bias were performed. Results A systematic review of nineteen cohort studies covering 17,205 patients, comparing impact of ERAS with conventional care on postoperative AKI was performed. Notably, the ERAS regimen did not increase the incidence of postoperative AKI compared with standard care (RR: 1.21; 95% CI: 0.96 to 1.52; I2 = 53%). Both goal-directed fluid therapy (RR: 1.26; 95% CI: 0.99–1.61; I2 = 55%) and restrictive fluid management (RR: 1.06; 95% CI: 0.57–1.98; I2 = 60%) had no significant effect on the incidence of postoperative AKI. There was no significant statistical difference between different AKI diagnostic criteria (P = 0.43; I2 = 0%). ERAS group had significantly shorter hospital stay (MD: −1.54; 95% CI: −1.91 to −1.17; I2 = 66%). There was no statistical difference in 30-day readmission rate (RR: 0.98; 95% CI: 0.80 to 1.20; I2 = 42%), 30-day reoperation rate (RR: 0.98; 95% CI: 0.71 to 1.34; I2 = 42%) and mortality (RR: 0.81; 95% CI: 0.59 to 1.11; I2 = 0%) between the two groups. Conclusions This meta-analysis suggests that ERAS protocols do not increase readmission or reoperation rates and mortality while significantly reducing LOS. Most importantly, the ERAS protocol was shown to have no promoting effect on the incidence of postoperative AKI. Even GDFT and restrictive fluid management cannot avoid the occurrence of postoperative AKI, and the ERAS protocol is still worth recommending and its safety is further confirmed.

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Section: Plos Onementioning

confidence: 99%

Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

Shen

Wang

et al. 2021

PLoS ONE

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“…Moreover, hospitalization time of patients has been demonstrated significantly decreased in patients who underwent the modified hysteroscopic-laparoscopic surgery compared with the patients with traditional surgery (4.50±0.50 days vs 5.50±0.75 days) in our study, which is considered to be another parameter for patient's cost. 18,19 Therefore, the modified hysteroscopic-laparoscopic surgery may reduce cost and bring more benefits for patients. Intraoperative bleeding volume is a crucial parameter to evaluate the quality of surgery, and it is significantly related to the recovery of patients after surgery.…”

Section: Discussionmentioning

confidence: 99%

A New Modified Hysteroscopic-Laparoscopic Surgery for Cesarean Scar Pregnancy of Stable Type III

Jiang¹,

Li²,

Liu³

et al. 2021

IJGM

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Objective To introduce a modified hysteroscopic-laparoscopic operation for cesarean scar pregnancy (CSP) of stable type III. Patients and Methods We retrospectively studied the case notes of 31 patients with stable type III cesarean scar pregnancy who underwent hysteroscopic-laparoscopic surgery in our hospital. Thirteen patients received the modified hysteroscopic-laparoscopic surgery (modified surgery group), and eighteen patients received traditional hysteroscopic-laparoscopic surgery (traditional surgery group). Results There was no significant difference in patients’ age, gestational age, number of previous cesarean sections, the serum human chorionic gonadotropin (hCG) level before surgery, gestational sac diameter, myometrium thickness between the two groups. In the modified hysteroscopic-laparoscopic surgery, the mean surgical time was 50.45±24.45 mins, the mean length of stay in hospital was 4.50±0.50 days, which was significantly shorter than the traditional surgery group (84.75±33.28 mins and 5.50±0.75 days, respectively). And the intraoperative hemorrhage in the modified group was also less than that in the traditional group (40.50±12.25 mL vs 75.33±25.45mL). Whereas the time for hCG normalization, postoperative vaginal bleeding and menstrual recovery had no significant difference between the modified surgery group and the traditional surgery group. There was no recurrence of CSP in both groups. Conclusion The modified hysteroscopic-laparoscopic surgery had shorter operation time, less blood loss, and sooner recovery time after surgery compared to traditional hysteroscopic-laparoscopic surgery, which could be more beneficial to our patients and should be applied in clinics generally.

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“…Moreover, rapid and large-scale implementation of ERAS program is feasible and effective [11]. Patient-center approach to optimize patients care and experience during the perioperative period, which has been shown to be effective in improving outcomes [12,13].…”

Section: Discussionmentioning

confidence: 99%

Effect of enhanced recovery after surgery in the managements of ankle fracture patients: a single-center retrospective cohort study

Yao

Liu

et al. 2020

Preprint

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Background Ankle fracture is common and the treatment is embarrassed. Enhanced Recovery After Surgery (ERAS) has been successfully adopted for the improvement of efficacy and quality. However, application of ERAS in ankle fracture patients especially at the early stage is variable and remains to be clarified. We intent to explore the effect of ERAS among ankle fracture patients. Methods There were 29 male and 51 female patients aged 41.71 ± 14. 51 years who were consecutively grouped into non-ERAS group (n = 40) and ERAS group (n = 40). Univariate analysis and multiple linear regression analysis were applied to assess the association in outcomes and variables. Results AOFAS at post-operative 3 month (PO3M) and post-operative 6 month (PO6M), costs, length of stay (LOS), and pre-operative LOS were verified significantly in univariate analysis. Multiple linear regression analysis revealed that ERAS can improve American Orthopaedic Foot and Ankle Society (AOFAS) at PO3M (β = 7.06, 95% CI, 4.45–9.65) and PO6M (β = 5.08, 95% CI, 2.35–7.80), reduce costs (β = -6885.13, 95% CI, -12089.40 - -1680.85) and LOS (β = -3.27, 95% CI, -4.97 - -1.57) among ankle fracture patients. With the numbers available, no significant differences were observed (p༞0.05) for the AOFAS at post-operative 12 month (PO12M) and post-operative 24 month (PO24M), complications, or opioids consumption. Conclusion We found ERAS is superior to general protocol among proper ankle fracture patients, which can enhance rehabilitation especially at the early stage and improve medical quality and efficiency by reducing costs and LOS. ERAS protocol may have a promising future and worth promoting.

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Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis

Cited by 144 publications

References 43 publications

Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis

A New Modified Hysteroscopic-Laparoscopic Surgery for Cesarean Scar Pregnancy of Stable Type III

Effect of enhanced recovery after surgery in the managements of ankle fracture patients: a single-center retrospective cohort study

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