Enhanced Recovery Program in Colorectal Surgery: A Meta-analysis of Randomized Controlled Trials
Massimiliano Greco
Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorGiovanni Capretti
Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorLuigi Beretta
Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorMarco Gemma
Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorNicolò Pecorelli
Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorCorresponding Author
Marco Braga
- [email protected]
- +39-02-26432667 | Fax: +39-02-26432871
Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Tel.: +39-02-26432667, Fax: +39-02-26432871, [email protected]Search for more papers by this authorMassimiliano Greco
Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorGiovanni Capretti
Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorLuigi Beretta
Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorMarco Gemma
Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorNicolò Pecorelli
Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Search for more papers by this authorCorresponding Author
Marco Braga
- [email protected]
- +39-02-26432667 | Fax: +39-02-26432871
Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
Tel.: +39-02-26432667, Fax: +39-02-26432871, [email protected]Search for more papers by this authorElectronic supplementary material: The online version of this article (doi:10.1007/s00268-013-2416-8) contains supplementary material, which is available to authorized users.
Abstract
Background
Meta-analyses in the literature show that enhanced recovery after surgery (ERAS) is associated with lower morbidity rate and shorter hospital stay after elective colorectal surgery. However, a recent Cochrane review did not indicate the ERAS pathway as being the new standard of care due to the limited number of published trials, together with their poor quality. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the impact of the ERAS pathway on overall morbidity, single postoperative complications, length of hospital stay, and readmission rate following colorectal surgery.
Methods
We searched BioMedCentral, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) for RCTs comparing the ERAS pathway to conventional perioperative care. No language restrictions were considered. A quality score was calculated for each trial included.
Results
A total of 2,376 patients in 16 RCTs were included in the analysis. The ERAS pathway was associated with a reduction of overall morbidity [relative ratio (RR) = 0.60, (95 % CI 0.46–0.76)], particularly with respect to nonsurgical complications [RR = 0.40, (95 % CI 0.27–0.61)]. The reduction of surgical complications was not significant [RR = 0.76, (95 % CI 0.54–1.08)]. The ERAS pathway shortened hospital stay (WMD = −2.28 days [95 % CI –3.09 to –1.47]), without increasing readmission rate.
Conclusions
The ERAS pathway reduced overall morbidity rates and shortened the length of hospital stay, without increasing readmission rates. A significant reduction in nonsurgical complications was evident, while no significant reduction was found for surgical complications.
Supporting Information
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| wjsbf06825-sup-0001.docxapplication/docx, 26.8 KB | Supplementary material 1 (DOCX 26 kb) |
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