The Application of Enhanced Recovery after Surgery for Upper Gastrointestinal Surgery: Meta-Analysis

Abstract

Background: Although enhanced recovery after surgery (ERAS) has made great progress in the field of surgery, the guidelines point to the lack of high-quality evidence in upper gastrointestinal surgery. Methods : Randomized controlled trials in four electronic databases that involved ERAS protocols for upper gastrointestinal surgery were searched through December 12, 2018. The primary endpoints were lung infection, urinary tract infection, surgical site infection, postoperative anastomotic leakage and ileus. The secondary endpoints were postoperative length of stay, the time from end of surgery to first flatus and defecation, and readmission rates. Subgroup analysis was performed based on the type of surgery. Results : A total of 17 studies were included. The results of the meta-analysis indicate that there was a decrease in rates of lung infection ( RR =0.50, 95%CI: 0.33 to 0.75 ), postoperative length of stay ( MD =-2.53, 95%CI: -3.42 to -1.65 ) , time until first postoperative flatus ( MD =-0.64, 95%CI: -0.84 to -0.45 ) and time until first postoperative defecation ( MD =-1.10, 95%CI: -1.74 to -0.47 ) in patients who received ERAS, compared to conventional care . However, other outcomes were not significant difference. There was no significant difference between ERAS and conventional care in rates of urinary tract infection (P=0.10), surgical site infection (P=0.42), postoperative anastomotic leakage (P=0.45), readmissions (P=0.31) and ileus (P =0.25). Conclusions : ERAS protocols can reduce the risk of postoperative lung infection and accelerating patient recovery time. Nevertheless, we should also consider further research ERAS should be performed undergoing gastrectomy and esophagectomy.

Results of an Enhanced Recovery after Surgery Protocol for Upper Gastrointestinal Surgery at a Super-Tertiary Referral Hospital in Thailand

“…A meta-analysis found the ERAS protocol in gastric cancer to be associated with a significant reduction in LOS (23). Mean LOS was reported to range from 5.4 to 14.1 days (19). Our study found a mean LOS after radical gastrectomy of 6.9 days, which is comparable to that previous study.…”

“…Previous study reported the benefit of ERAS protocol for reducing hospital LOS (19). Our study found the LOS in ERAS to be significantly shorter than in CC.…”

“…Subgroup analysis of subepithelial and epithelial tumors revealed a significant difference in LOS between groups. In patients with subepithelial tumors, the LOS in the ERAS group was 5 days, which is shorter than the previously reported range of 5.4-9.8 days (19,22). A meta-analysis found the ERAS protocol in gastric cancer to be associated with a significant reduction in LOS (23).…”

“…The benefit of ERAS protocol in UGI surgery, including hepatobiliary and pancreatic surgery, gastric surgery, and esophageal surgery, has been reported in several studies (18,19). Recently, the ERAS Society published evidence-based guidelines for enhanced recovery after gastrectomy and esophagectomy (10,11).…”

Paralytic ileus in the United States: A cross-sectional study from the national inpatient sample

“…50 However, in 2020, a meta-analysis comprising 1830 patients showed that ERAS may increase the risk of POI. 51 Our study shows that paralytic ileus hospitalizations increased from 2001 to 2011. Even if these protocols were applied during the study period, NIS database does not have separate ICD-9 codes to identify such them.…”