Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: A randomized clinical trial

Tanaka, Ryo; Lee, Sang Woong; Kawai, Masaru; Tashiro, Kunio; Kawashima, Seiichiro; Uchiyama, Kazuhisa

doi:10.1016/j.clnesp.2017.04.019

Cited by 17 publications

(48 citation statements)

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“…After initial evaluation, 597 studies were removed for being duplicates, 2204 for being irrelevant (as determined by reading the abstracts), and 67 studies were excluded for reasons determined by reading the full text (Additional file 2). 16 studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were included in the final meta-analysis. Figure 1 shows the work flow for the selection of studies.…”

Section: Literature Identificationmentioning

confidence: 99%

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

et al. 2020

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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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Section: Literature Identificationmentioning

confidence: 99%

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

et al. 2020

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“…After initial evaluation, 597 studies were removed for being duplicates, 2,204 for being irrelevant (as determined by reading the abstracts), and 67 studies were excluded for reasons determined by reading the full text (Additional File 2). 16 studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were included in the final meta-analysis. Fig.…”

Section: Literature Identificationmentioning

confidence: 99%

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

Huang

Zhu

Luo

et al. 2019

Preprint

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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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“…233 The majority of articles (81.5%) were published from 2008 onwards, with 50 (61.7%) published since 2011. 31,191,195,197,199,[201][202][203][205][206][207][208][209]211,212,214,216,219,220,222,[225][226][227][228][229][230][235][236][237][238][239][240][241][242][243]249,250,252,253,255,[257][258][259][260][262][263][264][265]267,…”

Section: Sample Characteristicsmentioning

confidence: 99%

“…Eight studies had an upper age limit for inclusion as follows: 75 years, 254,256 80 years 235,265,268 and 85 years. 202,243,264 By contrast, nine studies 199,204,207,218,220,221,223,242,267 exclusively recruited patients aged ≥ 60 years. Studies explicitly excluded patients who lived with cognitive impairment (n = 6 200,218,229,254,261,262 ), had 'psychiatric illness' (n = 6 196,202,210,231,254,266 ), had a history of stroke (n = 2 218,259 ), had 'mental disability' (n = 2 234,267 ), had periods of dizziness/confusion (n = 2 210,244 ) or were unable to consent (n = 4 31,209,226,236 ).…”

Section: Sample Characteristicsmentioning

confidence: 99%

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

Nunns

Shaw

Briscoe

et al. 2019

Health Serv Deliv Res

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Background Elective older adult inpatient admissions are increasingly common. Older adults are at an elevated risk of adverse events in hospital, potentially increasing with lengthier hospital stay. Hospital-led organisational strategies may optimise hospital stay for elective older adult inpatients. Objectives To evaluate the effectiveness and cost-effectiveness of hospital-led multicomponent interventions to reduce hospital stay for older adults undergoing elective hospital admissions. Data sources Seven bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database) were searched from inception to date of search (August 2017), alongside carrying out of web searches, citation searching, inspecting relevant reviews, consulting stakeholders and contacting authors. This search was duplicated, with an additional cost-filter, to identify cost-effectiveness evidence. Review methods Comparative studies were sought that evaluated the effectiveness or cost-effectiveness of relevant interventions in elective inpatients with a mean or median age of ≥ 60 years. Study selection, data extraction and quality assessment were completed independently by two reviewers. The main outcome was length of stay, but all outcomes were considered. Studies were sorted by procedure, intervention and outcome categories. Where possible, standardised mean differences or odds ratios were calculated. Meta-analysis was performed when multiple randomised controlled trials had the same intervention, treatment procedure, comparator and outcome. Findings were explored using narrative synthesis. Findings A total of 218 articles were included, with 80 articles from 73 effectiveness studies (n = 26,365 patients) prioritised for synthesis, including 34 randomised controlled trials conducted outside the UK and 39 studies from the UK, of which 12 were randomised controlled trials. Fifteen studies included cost-effectiveness data. The evidence was dominated by enhanced recovery protocols and prehabilitation, implemented to improve recovery from either colorectal surgery or lower limb arthroplasty. Six other surgical categories and four other intervention types were identified. Meta-analysis found that enhanced recovery protocols were associated with 1.5 days’ reduction in hospital stay among patients undergoing colorectal surgery (Cohen’s d = –0.51, 95% confidence interval –0.78 to –0.24; p < 0.001) and with 5 days’ reduction among those undergoing upper abdominal surgery (Cohen’s d = –1.04, 95% confidence interval –1.55 to –0.53; p < 0.001). Evidence from the UK was not pooled (owing to mixed study designs), but it echoed findings from the international literature. Length of stay usually was reduced with intervention or was no different. Other clinical outcomes also improved or were no worse with intervention. Patient-reported outcomes were not frequently reported. Cost and cost-effectiveness evidence came from 15 highly heterogeneous studies and was less conclusive. Limitations Studies were usually of moderate or weak quality. Some intervention or treatment types were under-reported or absent. The reporting of variance data often precluded secondary analysis. Conclusions Enhanced recovery and prehabilitation interventions were associated with reduced hospital stay without detriment to other clinical outcomes, particularly for patients undergoing colorectal surgery, lower limb arthroplasty or upper abdominal surgery. The impacts on patient-reported outcomes, health-care costs or additional service use are not well known. Future work Further studies evaluating of the effectiveness of new enhanced recovery pathways are not required in colorectal surgery or lower limb arthroplasty. However, the applicability of these pathways to other procedures is uncertain. Future studies should evaluate the implementation of interventions to reduce service variation, in-hospital patient-reported outcomes, impacts on health and social care service use, and longer-term patient-reported outcomes. Study registration This study is registered as PROSPERO CRD42017080637. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: A randomized clinical trial

Cited by 17 publications

References 0 publications

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

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

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

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