International Journal of Colorectal Disease

, Volume 27, Issue 12, pp 1549–1554 | Cite as

The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials

Review

Abstract

Objective

This study aimed to produce a comprehensive, up-to-date meta-analysis exploring the safety and efficacy of enhanced recovery programs after colorectal resection.

Method

Medline, Embase, and Cochrane database searches were performed for relevant studies published between January 1966 and April 2012. All randomized controlled trials on fast track (FT) colorectal surgery were reviewed systematically. The main end points were short-term morbidity, length of primary postoperative hospital stay, length of total postoperative stay, readmission rate, and mortality.

Results

Seven randomized controlled trials with 852 patients were included. The total length of hospital stay [mean difference (95 % confidence interval), −1.88 (−2.91, −0.86), p = 0.0003] and total complication rates [relative risk (95 % confidence interval), 0.69 (0.51, 0.93), p = 0.01] were significantly reduced in the enhanced recovery group. There was no statistically significant difference in readmission (risk ratio (RR) 0.90; 95 % confidence interval (CI) 0.52 to 1.53, p = 0.69) and mortality rates (RR 1.02; 95 % CI 0.40 to 2.57, p = 0.97).

Conclusion

Results suggested that enhanced recovery after surgery pathways can be able to reduce the length of stay and complication rates after major colorectal surgery without compromising patient safety. Future studies have to define the active elements in order to improve future fast track protocols.

Keywords

ERAS pathway Colorectal surgery Meta-analysis 

References

  1. 1.
    Schoetz DJ Jr, Bockler M, Rosenblatt MS, Malhotra S, Roberts PL, Murray JJ et al (1997) “Ideal” length of stay after colectomy: whose ideal? Dis Colon Rectum 40:806–810PubMedCrossRefGoogle Scholar
  2. 2.
    Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 345:763–764PubMedCrossRefGoogle Scholar
  3. 3.
    Reissman P, Teoh TA, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD (1995) Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg 222:73–77PubMedCrossRefGoogle Scholar
  4. 4.
    Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245:867–872PubMedCrossRefGoogle Scholar
  5. 5.
    Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641PubMedCrossRefGoogle Scholar
  6. 6.
    Wilmore DW, Kehlet H (2001) Management of patients in fast track surgery. BMJ 322:473–476PubMedCrossRefGoogle Scholar
  7. 7.
    Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90:1497–1504PubMedCrossRefGoogle Scholar
  8. 8.
    Bradshaw BG, Liu SS, Thirlby RC (1998) Standardized perioperative care protocols and reduced length of stay after colon surgery. J Am Coll Surg 186:501–506PubMedCrossRefGoogle Scholar
  9. 9.
    Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859PubMedCrossRefGoogle Scholar
  10. 10.
    DiFronzo LA, Yamin N, Patel K, O’Connell TX (2003) Benefits of early feeding and early hospital discharge in elderly patients undergoing open colon resection. J Am Coll Surg 197:747–752PubMedCrossRefGoogle Scholar
  11. 11.
    Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92:1354–1362PubMedCrossRefGoogle Scholar
  12. 12.
    Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136:842–847PubMedCrossRefGoogle Scholar
  13. 13.
    Serclova Z, Dytrych P, Marvan J, Nova K, Hankeova Z, Ryska O et al (2009) Fast-track in open intestinal surgery: prospective randomized study. Clin Nutr 28:618–624 (Clinical Trials Gov Identifier no. NCT00123456)PubMedCrossRefGoogle Scholar
  14. 14.
    Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875PubMedCrossRefGoogle Scholar
  15. 15.
    Kjaergard LL, Villumsen J, Gluud C (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135:982–989PubMedGoogle Scholar
  16. 16.
    Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613PubMedCrossRefGoogle Scholar
  17. 17.
    Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG et al (2008) Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 336:601–605PubMedCrossRefGoogle Scholar
  18. 18.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097PubMedCrossRefGoogle Scholar
  19. 19.
    Walter CJ, Collin J, Dumville JC, Drew PJ, Monson JR (2009) Enhanced recovery in colorectal resections: a systematic review and meta-analysis. Color Dis 11:344–353CrossRefGoogle Scholar
  20. 20.
    Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP (2009) Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Color Dis 24:1119–1131CrossRefGoogle Scholar
  21. 21.
    Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440PubMedCrossRefGoogle Scholar
  22. 22.
    Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev CD007635Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of General Surgery, Affiliated HospitalQingdao University Medical CollegeQingdaoChina

Personalised recommendations