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.

Effect of Ultrasound-Guided Quadratus Lumborum Block Preemptive Analgesia on Postoperative Recovery of Patients with Open Radical Colon Cancer Surgery: A Retrospective Study

“…On the other hand, it accelerates the fast recovery and early discharge. 25,47,48 The dosage of remifentanil, intraoperative sufentanil and postoperative sufentanil in Group Q were significantly less than Group C, respectively (P<0.05), indicating that QLB preemptive analgesia can significantly reduce postoperative pain, which is consistent with the results of Kadam et al 49 In a systematic review and meta-analysis, Korgvee et al 50 revealed that QLB could reduce postoperative opioid consumption and prolonged the time to the first rescue opioid analgesic after abdominal and hip surgery. Surgical factors, residual anesthetics and postoperative analgesics may cause adverse reactions such as drowsiness, nausea, and vomiting.…”

Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

“…Currently, more generalized perioperative care programs are being studied and implemented in the form of ERAS protocols. 62 As part of the ERAS protocols, lifestyle interventions (e.g., alcohol cessation) are introduced in daily practice. 63 – 65 In addition, there is more focus on preoperative malnutrition and impaired physical capacity, which are shown to be negative prognostic factors for postoperative complications in this meta-analysis.…”

Application of the Concept of Enhanced Recovery after Surgery in Total Laparoscopic Radical Gastrectomy

“…Enhanced recovery after surgery (ERAS) was first reported by a Danish surgeon Kehlet, and it was successfully applied in the elective surgery of colorectal tumor [ 5 ]. ERAS organically combining new techniques in anesthesiology, pain management, nutritional support, and surgery with improved traditional postoperative care aims to reduce or alleviate perioperative traumatic stress, promote postoperative recovery of intestinal function, facilitate postoperative rehabilitation, shorten length of stay, and lower medical expenses through multidisciplinary collaboration [ 6 , 7 ]. In the present study, the effectiveness and safety of ERAS in total laparoscopic radical gastrectomy were assessed.…”