Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis

Abstract

Background This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. Methods The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. Results Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) −3.23 (95 per cent c.i. −4.62 to −1.85) days; P < 0.001) and solid (−3.84 (−5.09 to −2.60) days; P < 0.001) intake, time to passage of first stool (MD −1.38 (−1.82 to −0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (−4.87 to −1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) −0.04, 95 per cent c.i. −0.08 to −0.01; P = 0.015), less delayed gastric emptying (RD −0.11, −0.22 to −0.01; P = 0.039) and a shorter duration of hospital stay (MD −2.33 (−2.98 to −1.69) days; P < 0.001) without a higher readmission rate. Conclusion ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.

Costs and clinical benefits of enhanced recovery after surgery (ERAS) in pancreaticoduodenectomy: an updated systematic review and meta-analysis

“…Regarding secondary outcomes, this review found a significant reduction in length of stay of 3.15 days following implementation of ERAS protocols; a finding that is consistent with previous reviews on pancreatic surgery (Kuemmerli et al 2022;Sun et al 2020;Wang et al 2020;Xiong et al 2016). However, it is worth noting the presence of heterogeneity in the LOS.…”

“…This present meta-analysis included a total of 31 studies and 5382 patients making it the largest study to date on this topic. Previous systematic reviews and meta-analyses have concluded that implementation of ERAS pathways may reduce length of hospital stay and overall complications in pancreatoduodenectomy without increasing rates of mortality and readmission (Coolsen et al 2013;Bin Ji et al 2018;Kagedan et al 2015;Kuemmerli et al 2022;Sun et al 2020;Wang et al 2020;Xiong et al 2016).…”

Principles of enhanced recovery in gastrointestinal surgery

“…There was also a significant reduction in time to first flatus of 0.8 days. Further meta-analysis revealed similar results for emergency laparotomy [ 40 ] and for pancreatoduodenectomy [ 41 ] with an associated reduction of delayed gastric emptying, as well as for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy [ 42 ], liver resection [ 43 ], and even for liver transplantion [ 44 ] where a 55% reduction in intensive care unit was associated with the application of ERAS concept. A summary of all most recent meta-analysis for each surgical specialty is provided on Table 1 .…”

Residual gastric volume after 3 h of the ingestion of an oral supplement containing carbohydrates alone or associated with whey protein: a randomized crossover pilot study

“…One of the most important prescriptions of enhanced recovery after surgery protocols is the reduction of preoperative fasting time in opposition to the traditional recommendation of overnight fasting (Kuemmerli et al 2022 ; De-Aguilar-Nascimento et al 2017 ). This change from prolonged fast to only 2–3 h after the ingestion of 200–400 mL of carbohydrate (CHO)-enriched supplements is not only safe (Smith et al 2014 ) but also recommended by various societies of anesthesiologists (Smith et al 2011 ), surgeons, and nutrition (Weimann et al 2021 ).…”