Effect of enhanced recovery after surgery on inflammatory bowel disease surgery: A meta-analysis

Abstract

BACKGROUND The purpose of enhanced recovery after surgery (ERAS) was to reduce surgical pressure and accelerate postoperative functional recovery. Although the application of biologics in treating inflammatory bowel disease (IBD) has changed treatment strategies, most patients with IBD still require surgery. AIM To evaluate the advantage of ERAS in IBD surgery. METHODS The PubMed, EMBASE and Cochrane Library databases were searched from inception to March 21, 2021 to find eligible studies. The primary outcome was postoperative complications, and the secondary outcomes included operation time, time to first flatus, time to bowel movement, postoperative hospital stay and readmission. The PROSPERO registration ID of this meta-analysis is CRD42021238052. RESULTS A total of eight studies involving 1939 patients were included in this meta-analysis. There were no differences in baseline information between the ERAS group and the non-ERAS group. After pooling up all of the data, no significant difference was found between the ERAS group and the non-ERAS group in terms of postoperative overall complications [odds ratio = 0.82, 95% confidence interval (CI) = 0.66 to 1.02, P = 0.08]. The ERAS group had a lower prevalence of anastomotic fistula (odds ratio = 0.36, 95%CI = 0.13 to 0.95, P = 0.04), less time to first flatus [mean difference (MD) = -2.03, 95%CI = -3.89 to -0.17, P = 0.03], less time to bowel movement (MD = -1.08, 95%CI = -1.60 to -0.57, P < 0.01) and shorter postoperative hospital stays (MD = -1.99, 95%CI = -3.27 to -0.71, P < 0.01) than the non-ERAS group. CONCLUSION ERAS was effective for the quicker recovery in IBD surgery and did not lead to increased complications.

Peri-Operative Outcomes of Patients with Inflammatory Bowel Disease After the Introduction of an ERAS Protocol – A Retrospective Cohort Review

“…Additionally, IBD patients are often malnourished and immunosuppressed, which increases the risk of postoperative complications and prolongs LOS. 11 Despite this however, our LOS is in-fact less than other fast track IBD reports from Enriquez-Navascues et al (8 days) 17 and Dai et al (10.9 days). 19 Given that the majority of currently available literature in this space has assessed outcomes following fast track surgery in ileocolic resection for CD, we performed a sub-group analysis of this cohort.…”

Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients?

“…This strategy includes preoperative carbohydrate loading, early oral feeding, and early postoperative activity[ 11 ]. The ERAS protocol has been proven to reduce the rate of postoperative complications and shorten the postoperative hospital stay for patients with digestive tract cancer [ 12 , 13 ].…”