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.

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

10.21203/rs.2.13659/v3 ◽

2019 ◽

Author(s):

Zhen-Dong Huang ◽

Hui-Yun Gu ◽

Jie Zhu ◽

Jie Luo ◽

Xian-Feng Shen ◽

...

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Meta Analysis ◽

Gastrointestinal Surgery ◽

Lung Infection ◽

Conventional Care ◽

Site Infection ◽

Significant Difference ◽

Postoperative Length ◽

Upper Gastrointestinal

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.

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

10.21203/rs.2.13659/v1 ◽

2019 ◽

Author(s):

Zhen-Dong Huang ◽

Hui-Yun Gu ◽

Jie Zhu ◽

Jie Luo ◽

Xian-Feng Shen ◽

...

Keyword(s):

Urinary Tract Infection ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Meta Analysis ◽

Gastrointestinal Surgery ◽

Lung Infection ◽

Conventional Care ◽

Site Infection ◽

Significant Difference ◽

Upper Gastrointestinal

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, P <0.01), PLOS (MD =-2.53, 95%CI: -3.42 to -1.65, P <0.01), time until first postoperative flatus (MD =-0.64, 95%CI: -0.84 to -0.45, P <0.01) and time until first postoperative defecation (MD =-1.10, 95%CI: -1.74 to -0.47, P <0.01) in patients who received ERAS, compared to conventional care. However, other outcomes were no 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 infection and accelerating patient recovery time. Nevertheless, we should also consider further research ERAS should be performed in elderly patients undergoing gastrectomy.

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Systematic Review and Meta‐Analysis of Enhanced Recovery After Surgery Versus Conventional Care in Patients Undergoing Radical Prostatectomy

AORN Journal ◽

10.1002/aorn.13268 ◽

2020 ◽

Vol 112 (6) ◽

pp. 711-714

Author(s):

George Allen

Keyword(s):

Systematic Review ◽

Radical Prostatectomy ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Meta Analysis ◽

Conventional Care

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

Surgery Gastroenterology and Oncology ◽

10.21614/sgo-25-5-248 ◽

2020 ◽

Vol 25 (5) ◽

pp. 248

Author(s):

Thammawat Parakonthun ◽

Thikhamporn Tawantanakorn ◽

Jirawat Swangsri ◽

Tharathorn Suwatthanarak ◽

Nicha Srisuworanan ◽

...

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gastrointestinal Surgery ◽

Referral Hospital ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Upper Gastrointestinal

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Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery

Nutrients ◽

10.3390/nu13082655 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2655

Author(s):

Maria Wobith ◽

Arved Weimann

Keyword(s):

Enteral Nutrition ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gastrointestinal Surgery ◽

Nutritional Therapy ◽

Oral Feeding ◽

Calorie Intake ◽

Obese Patients ◽

Oral Nutritional Supplements ◽

Upper Gastrointestinal

Nowadays, patients undergoing gastrointestinal surgery are following perioperative treatment in enhanced recovery after surgery (ERAS) protocols. Although oral feeding is supposed not to be stopped perioperatively with respect to ERAS, malnourished patients and inadequate calorie intake are common. Malnutrition, even in overweight or obese patients, is often underestimated. Patients at metabolic risk have to be identified early to confirm the indication for nutritional therapy. The monitoring of nutritional status postoperatively has to be considered in the hospital and after discharge, especially after surgery in the upper gastrointestinal tract, as normal oral food intake is decreased for several months. The article gives an overview of the current concepts of perioperative enteral nutrition in patients undergoing gastrointestinal surgery.

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Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136166 ◽

2018 ◽

Vol 94 (1118) ◽

pp. 678-693 ◽

Cited By ~ 22

Author(s):

Qi-Feng Deng ◽

Hui-Yun Gu ◽

Wu-ya Peng ◽

Qiong Zhang ◽

Zheng-Dong Huang ◽

...

Keyword(s):

Systematic Review ◽

Mortality Rate ◽

Complication Rate ◽

Readmission Rate ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Meta Analysis ◽

Postoperative Recovery ◽

Transfusion Rate ◽

Significant Difference

Study designSystematic review with meta-analysis.ObjectivesTo evaluate the effects of enhanced recovery after surgery (ERAS) on the postoperative recovery of patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA).MethodsThe PubMed, Embase, Cochrane and ISI Web of Science databases were searched to identify literature including randomised controlled trials (RCTs), cohort studies and case–control studies through 2 May 2018. The analysed outcomes were mortality rate, transfusion rate, range of motion (ROM), 30-day readmission rate, postoperative complication rate and in-hospital length of stay (LOS).ResultsA total of 25 studies involving 16 699 patients met the inclusion criteria and were included in the meta-analysis. Compared with conventional care, ERAS was associated with a significant decrease in mortality rate (relative risk (RR) 0.48, 95% CI 0.27 to 0.85), transfusion rate (RR 0.43, 95% CI 0.37 to 0.51), complication rate (RR 0.74, 95% CI 0.62 to 0.87) and LOS (mean difference (MD) −2.03, 95% CI −2.64 to −1.42) among all included trials. However, no significant difference was found in ROM (MD 7.53, 95% CI −2.16 to 17.23) and 30-day readmission rate (RR 0.86, 95% CI 0.56 to 1.30). There was no significant difference in complications of TKA (RR 0.84, 95% CI 0.34 to 2.06) and transfusion rate in RCTs (RR 0.66, 95% CI 0.15 to 2.88) between the ERAS group and the control group.ConclusionsThis meta-analysis showed that ERAS significantly reduced the mortality rate, transfusion rate, incidence of complications and LOS of patients undergoing TKA or THA. However, ERAS did not show a significant impact on ROM and 30-day readmission rate. Complications after hip replacement are less than those of knee replacement, and the young patients recover better.Level of evidenceLevel 1.

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Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies

The American Surgeon ◽

10.1177/0003134820954846 ◽

2020 ◽

pp. 000313482095484

Author(s):

Andrés Zorrilla-Vaca ◽

Gabriel E. Mena ◽

Juan Cata ◽

Ryan Healy ◽

Michael C. Grant

Keyword(s):

Systematic Review ◽

Colorectal Surgery ◽

Observational Studies ◽

Enhanced Recovery ◽

Meta Analysis ◽

Kidney Injury ◽

Conventional Care ◽

Recovery Programs ◽

Enhanced Recovery Programs ◽

Postoperative Aki

Background Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P = .001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value = .95). Conclusions Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.

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