Background: There is a lack of systematic review exploring the
effectiveness of Enhanced Recovery After Surgery (ERAS) in hysterectomy
in promoting better recovery. Objectives: To synthesize the best
available evidence of the effectiveness of ERAS intervention in
promoting better recovery of shortened length of hospital stay (primary
outcome), lower readmission, and complication rates (secondary outcomes)
among patients undergoing hysterectomy due to benign conditions as
compared to conventional perioperative care. Search Strategy: Seven
electronic databases were searched from the date of inception to
December 2020. Selection Criteria: Randomized controlled trials, cohort
studies, or quasi-experimental studies published in English examining
the effects of ERAS for women diagnosed with benign gynecologic diseases
and underwent either abdominal or laparoscopic hysterectomy were
included. Data Collection and Analysis: Two reviewers independently
conducted database search, data extraction, and methodological quality
assessment. Meta-analyses were performed for all outcomes. The overall
quality of evidence was assessed using GRADE. Main Results: Nine studies
were included in this review. Meta-analysis showed a statistically
significant reduction in length of hospital stay (SMD = -0.76, 95% CI
[-1.06, -0.46], Z = 4.72, p < .00001), readmission rate
(RR = 0.65, 95% CI [0.44-0.96]; Z = 2.16, p = .03) and complication
rate (RR = 0.61, 95% CI [0.48-0.77]; Z = 4.17, p <
.0001), with high certainty of evidence. Conclusions: The effectiveness
of ERAS in improving recovery indicates that hospitals could adopt the
protocol to improve patients’ health and wellbeing. Future studies can
focus more on standardizing the protocol’s elements.
Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review and meta-analysis
