Meta‐analysis of Enhanced Recovery After Surgery (ERAS) Protocols in Emergency Abdominal Surgery

Abstract

Objectives To evaluate enhanced recovery after surgery (ERAS) protocols in emergency abdominal surgery. Methods The electronic data sources were explored to capture all studies that evaluated the impact of ERAS protocols in patients who underwent emergency abdominal surgery. The quality of randomised and non-randomised studies was evaluated by the Cochrane tool and the Newcastle-Ottawa scale, respectively. Random or fixed effects modelling were utilised as indicated. Results Six comparative studies, enrolling 1334 patients, were eligible. ERAS protocols resulted in shorter postoperative time to first flatus (mean difference: -1.40, P \ 0.00001), time to first defecation (mean difference: -1.21, P = 0.02), time to first oral liquid diet (mean difference: -2.30, P \ 0.00001), time to first oral solid diet (mean difference: -2.40, P \ 0.00001) and length of hospital stay (mean difference: -3.09, -2.80, P \ 0.00001). ERAS protocols also resulted in lower risks of total complications (odds ratio: 0.50, P \ 0.00001), major complications (odds ratio: 0.60, P = 0.0008), pulmonary complications (odds ratio: 0.38, P = 0.0003), paralytic ileus (odds ratio: 0.53, 0.88, P = 0.01) and surgical site infection (odds ratio: 0.39, P = 0.0001). Both ERAS and non-ERAS protocols resulted in similar risk of 30-day mortality (risk difference: -0.00, P = 0.94), need for re-admission (risk difference: -0.01, P = 0.50) and need for re-operation (odds ratio: 0.83, P = 0.50). Conclusions Although ERAS protocols are commonly used in elective settings, they are associated with favourable outcomes in emergency settings as indicated by reduced post-operative complications, accelerated recovery of bowel function and shorter post-operative hospital stay without increasing need for re-admission or re-operation. There should be an effort to incorporate ERAS protocols into emergency abdominal surgery settings.Shahab Hajibandeh and Shahin Hajibandeh had equal contributions in this study proposing joined first authorship.

Early Oral Feeding Compared With Traditional Postoperative Care in Patients Undergoing Emergency Abdominal Surgery for Perforated Duodenal Ulcer

“…ERAS pathways can be used in emergency surgery cases where there is a risk of repair site leak in perforated duodenal ulcer. Hospital stay duration was significantly less in the early oral feeding group than the traditional postoperative care group, similar to previous studies [13,18]. Early oral feeding after perforated duodenal ulcer repair did not result in the repair site leak in any patients.…”

Surgical Site Infection After Emergency Abdominal Surgery in China: A Multicenter Prospective Study

“…his study found that the incidence of postoperative SSI in EAS patients was 7.5%, with Escherichia coli infection being the most common, which is comparable to that reported worldwide [9,14,15]. The occurrence of SSI signi cantly prolonged the hospital stay of patients and increased medical costs.…”

The Best Strategy for Nasogastric Tube Removal in Patients with Acute Appendicitis Complicated with Ileus: A Case Report and Review.

“…The trend of postoperative care followed the concept of "Enhanced Recovery After Surgery (ERAS)" nowadays, advocating to remove the inserted tubes, including NG tubes, as well as commence oral feeding as soon as possible, and to reserve the use of opioids for pain control [27]. The concept was initially adopted in elective surgeries; however, it was also con rmed to decrease the complications and fasten the recovery of bowel motility after emergent abdominal surgeries in recent studies [28]. Early removal of NG tubes after the elective surgeries tends to decrease the risk of complications, accelerate the return to oral feeding, and signi cantly reduce patients' discomfort [29].…”