Clinical efficacy of enhanced recovery after surgery (ERAS) program in patients undergoing radical prostatectomy: a systematic review and meta-analysis

Zhao, Yongfei; Zhang, Shaobo; Liu, Bianjiang; Li, Jie; Hong, Hao

doi:10.1186/s12957-020-01897-6

Cited by 29 publications

(18 citation statements)

References 19 publications

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“…Mukkala et al Unplanned visits after radical prostatectomy 9 © 2021 Canadian Urological Association flatulating/defecation time, shorter time to drain removal, while having no effect on re-admission rate or blood loss. 84,85 A meta-analysis from Lv et al showed that ERAS/FTS had a nonsignificant effect on the re-admission rate outcome, hence favoring conventional care. 84 Further tailoring and extension of ERAS/FTS programs, using the synthesis herein, can potentially help for longer-term outcomes, such as UPV.…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

Mukkala¹,

Song²,

Lee³

et al. 2021

CUAJ

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Introduction: Unplanned visits (UPV) — re-admissions and emergency room (ER) visits — are markers of healthcare system quality. Radical prostatectomy (RP) is a commonly performed cancer procedure, where variation in UPV represents a gap in care for prostate cancer patients. Here, we systematically synthesize the rates, reasons, predictors, and interventions for UPV after RP, to inform evidence-based quality improvement (QI) initiatives. Methods: A systematic review was performed for studies from 2000–2020 using keywords: “re-admission,” “emergency room/department,” “unplanned visit,” and “prostatectomy.” Studies that focused on UPV following RP and that reported rates, reasons, predictors, or interventions, were included. Data was extracted via a standardized form. Meta-analysis was completed. Results: Sixty studies, with 406 107 RP patients, were eligible; 16 028 UPV events (~5%) were analyzed from 317 050 RP patients. UPV rates after RP varied between studies (ER visit range 6–24%; re-admissions range 0–56%). The 30-day and 90-day ER visit rates were 12% and 14%, respectively; the 30-day and 90-day re-admission rates were 4% and 9%, respectively. A total of 55% of all re-admissions after RP are directly due to postoperative genitourinary (GU)-related complications such as strictures, obstructions, fistula, bladder-related, incontinence, urine leak, renal problems, and other unspecified urinary complications. The next most common re-admission reasons were anastomosis-related, infection-related, cardiovascular/pulmonary events, and wound-related issues. Thirty-four percent of all ER visits after RP are directly due to urine-related issues such as retention, urinoma, obstruction, leak, and catheter problems. The next most common ER visit reasons were abdominal/gastrointestinal issues, infection-related, venous thromboembolic events, and wound-related issues. Predictors for increased re-admission included: open RP, lymph node dissection, Charlson comorbidity index≥2, low surgeon/hospital case volume, and socioeconomic determinants of health. Of the 10 interventions evaluated, a 3.4% average reduction in UPV rate was observed, highlighting an approximate two-fold decrease. Meta-analysis demonstrated a significant benefit of interventions over controls with odds ratio 0.62 (95% confidence interval 0.46–0.84). Interventions that used multidisciplinary, nurse-centered, programs, with patient self-care/empowerment were more beneficial than algorithmic patient care pathways and preoperative patient education. Conclusions: Twenty years of international, retrospective, experience suggests UPV after RP are often related to GU complications, infection- or wound-related factors. QI interventions to reduce UPV should target these factors. While many re-admissions after RP appear to be unavoidable, ER visits have more opportunity for volume reduction by QI. The interventions evaluated herein have potential to reduce UPV after RP.

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Section: Cuaj -Original Researchmentioning

confidence: 99%

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

Mukkala¹,

Song²,

Lee³

et al. 2021

CUAJ

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“…The concept of ERAS was first proposed by Dr. Engelman in 1994 (12). In recent years, this multidisciplinary and multimodal perioperative rehabilitation concept has been widely applied in surgeries of various disciplines: colorectal (13), liver (14), gynecological (15), urologic (16), spinal (17), and gastrointestinal surgery (18). Moreover, recent studies have indicated that patients treated with the ERAS program during hepatectomy, laparoscopic colorectal surgery, and spinal surgery have a significant reduction in LOS and risk of postoperative complications (13,14,17).…”

Section: Introductionmentioning

confidence: 99%

The effect of the enhanced recovery after surgery program on lung cancer surgery: a systematic review and meta-analysis

Li¹,

Wang²,

Qu³

et al. 2021

J Thorac Dis

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Background: Lung cancer is one of the most common causes of cancer-related death worldwide. The enhanced recovery after surgery (ERAS) program is an effective evidence-based multidisciplinary protocol of perioperative care. However, the roles of ERAS in lung cancer surgery remain unclear. This systematic review and meta-analysis aimed to investigate the short-term impact of the ERAS program on lung resection surgery, especially in relation to postoperative complications. Methods: A systematic literature search of PubMed, EMBASE, and the Cochrane Library databases until October 2020 was performed to identify the studies that implemented an ERAS program in lung cancer surgery. The studies were selected and subjected to data extraction by 2 reviewers independently, which was followed by quality assessment. A random effects model was used to calculate overall effect sizes. Risk ratio (RR), risk difference (RD), and standardized mean difference (SMD) with 95% confidence interval (CI) served as the summary statistics for meta-analysis. Subgroup analysis and sensitivity analysis were subsequently performed. Results: A total of 21 studies with 6,480 patients were included. The meta-analysis indicated that patients in the ERAS group had a significantly reduced risk of postoperative complications (RR =0.64; 95% CI: 0.52 to 0.78) and shortened postoperative length of stay (SMD=−1.58; 95% CI: −2.38 to −0.79) with a significant heterogeneity. Subgroup analysis showed that the risks of pulmonary (RR =0.58; 95% CI: 0.45 to 0.75), cardiovascular (RR =0.73; 95% CI: 0.59 to 0.89), urinary (RR =0.53; 95% CI: 0.32 to 0.88), and surgical complications (RR =0.64; 95% CI: 0.42 to 0.97) were significantly lower in the ERAS group. No significant reduction was found in the in-hospital mortality (RD =0.00; 95% CI: −0.01 to 0.00) and readmission rate (RR =1.00; 95% CI: 0.76 to 1.32). In the qualitative review, most of the evidence reported significantly decreased hospitalization costs in the ERAS group. Conclusions: The implementation of an ERAS program for surgery of lung cancer can effectively reduce risks of postoperative complications, length of stay, and costs of patients who have undergone lung cancer surgery without compromising their safety.

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“…Although the benefits of the ERAS protocol in perioperative patient care in operations such as gastrointestinal surgeries have been well defined, its safety and effectiveness in LRP are not yet clear. In a meta-analysis of 784 patients who underwent LRP it was found that the ERAS protocol shortened the LOS [11]. Similarly, in a study of 301 patients who underwent LRP, it significantly reduced the LOS.…”

Section: Discussionmentioning

confidence: 94%

Comparison of enhanced recovery after surgery protocol and conventional approach after laparoscopic transperitoneal radical prostatectomy: a retrospective analysis

2021

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Background Although open radical prostatectomy has been used in the treatment of localized prostate cancer for a long time, minimally invasive surgical approaches such as laparoscopic radical prostatectomy and robot-assisted radical prostatectomy have recently gained importance in order to improve postoperative results and shorten hospital stay. Although the enhanced recovery after surgery (ERAS) protocol was first defined for gastrointestinal surgeries in 2001, it has now been used in gynecological, orthopedic, thoracic and urological surgeries. In our study, we aimed to compare the results of the ERAS protocol with the conventional approach in patients who underwent laparoscopic radical prostatectomy. Methods There is a retrospective analysis of 70 patients who underwent laparoscopic radical prostatectomy at Kayseri City Hospital between May 2018 and January 2021. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS, Armonk, NY, USA). Seventy patients were included in the study. While 48 patients who underwent perioperative care with the traditional approach were included in the conventional group, 22 patients were included in the ERAS group. Age, comorbidities, preoperative PSA level, digital rectal examination findings, preoperative imaging, extra prostatic spread and lymph node involvement, location of tumors, time between biopsy and surgery, lymphadenectomy status, and histopathological findings of transrectal ultrasound biopsy and prostatectomy specimens were recorded for each patient. Initiation of enteral feeding, time to first defecation, duration of antibiotic use, ileus development rate and length of hospital stay (LOS) were compared for both groups. Results The mean age of 48 patients in the conventional group was 63.37 ± 7.01 years, while the mean age of 22 patients in the ERAS group was 66.36 ± 5.31 years (p = 0.080). Although the first defecation time was shorter in the ERAS group (4.75 ± 3.21 vs. 3.73 ± 2.12 days, p = 0.179), there was no statistically significant difference. Ileus developed in 10 (20.8%) patients in the conventional group and 2 (9.1%) in the ERAS group. Use of antibiotics in the postoperative period in the conventional group (5.83 ± 3.62 vs. 3.18 ± 2.42 days, p = 0.003) and LOS (7.92 ± 3.26 vs. 5.91 ± 2, 15 days, p = 0.011) were statistically significantly longer. Conclusion In summary, ERAS protocol is associated with short LOS, time to initiation of enteral feeding and duration of antibiotics use. There was no statistically significant difference in the rate of ileus and time to first defecation between the two groups. Randomized prospective studies on heterogeneous and larger patient groups are needed to confirm our findings.

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Clinical efficacy of enhanced recovery after surgery (ERAS) program in patients undergoing radical prostatectomy: a systematic review and meta-analysis

Cited by 29 publications

References 19 publications

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

The effect of the enhanced recovery after surgery program on lung cancer surgery: a systematic review and meta-analysis

Comparison of enhanced recovery after surgery protocol and conventional approach after laparoscopic transperitoneal radical prostatectomy: a retrospective analysis

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