Enhanced recovery after surgery protocols and emergency surgery: a systematic review and meta‐analysis of randomized controlled trials

Abstract

BackgroundThis systematic review and meta‐analysis seeks to assess the modified protocols used and patient outcomes when enhanced recovery after surgery (ERAS) protocols are utilized in an emergency setting.MethodsPubMed, MEDLINE, EMBASE and Cochrane Central Registry of Controlled Trials were comprehensively searched until 13 March 2023. The Cochrane Risk of Bias Assessment Tool was used to assess for bias, along with funnel plot asymmetry. We present log risk ratios for dichotomous variables and raw mean differences for continuous variables.ResultsSeven randomized trials were included, comprising 573 patients. Results of the primary outcomes when comparing ERAS to standard care are as follows; withdrawal of nasogastric tube (raw mean difference −1.87 CI: −2.386 to −1.359), time to first liquid diet (raw mean difference −2.56 CI: −3.435 to −1.669), time to first solid diet (raw mean difference −2.35 CI: −2.933 to −1.76), time to first flatus (raw mean difference −2.73 CI: −5.726 to 0.257), time to first stool passed (raw mean difference −1.83 CI: −2.307 to −1.349), time to removal of drains (raw mean difference −3.23 CI: −3.609 to −2.852), time to removal of urinary catheter (raw mean difference −1.57 CI: −3.472 to 0.334), mean pain score (raw mean difference −1.79 CI: −2.222 to −1.351) and length of hospital stay (raw mean difference −3.16 CI: −3.688 to −2.63).ConclusionsThe adoption of ERAS protocols in an emergency surgery setting was observed to enhance patient recovery, while not indicating any statistically significant increase in adverse outcomes.

Enhanced recovery after surgery (ERAS) in Emergency and Trauma Surgery

“…The above fact has been underlined by the encouraging results of several recent narrative reviews, systematic reviews, and meta-analyses on this topic [54][55][56][57][58][59][60].…”

The advantages of general anesthesia subthalamic deep brain stimulation for Parkinson's disease in the enhanced recovery after surgery: A randomized clinical trial

“…Simultaneously, the pressure of medical and economic factors has led to a reduction in hospital stays, treatment costs, and the workload of medical staff, while increasing bed turnover and optimizing medical resource utilization. These factors have given rise to the development of ERAS 11–13 . ERAS, based on the principles of evidence‐based medicine, utilizes multidisciplinary and multimodal perioperative management to alleviate perioperative stress reactions, thereby reducing postoperative complications, shortening hospital stays, facilitating physical and psychological rehabilitation, and lowering medical costs.…”

“…These factors have given rise to the development of ERAS. 11 , 12 , 13 ERAS, based on the principles of evidence‐based medicine, utilizes multidisciplinary and multimodal perioperative management to alleviate perioperative stress reactions, thereby reducing postoperative complications, shortening hospital stays, facilitating physical and psychological rehabilitation, and lowering medical costs. Surgery can induce a range of physiological and psychological stress reactions in patients.…”