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Enhanced Recovery Program in Colorectal Surgery: A Meta-analysis of Randomized Controlled Trials

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.

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Acknowledgments

We thank Michael John (BA) of the Vita-Salute San Raffaele Medical School in Milan for the English language editing of this manuscript, and Teresa Greco (MSc) for statistical support. We also thank the ERAS Society® for its contribution to improving perioperative care pathways in colorectal surgery.

Conflict of interest

None.

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Correspondence to Marco Braga.

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Greco, M., Capretti, G., Beretta, L. et al. Enhanced Recovery Program in Colorectal Surgery: A Meta-analysis of Randomized Controlled Trials. World J Surg 38, 1531–1541 (2014). https://doi.org/10.1007/s00268-013-2416-8

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  • DOI: https://doi.org/10.1007/s00268-013-2416-8

Keywords

  • Readmission Rate
  • Relative Ratio
  • Enhance Recovery After Surgery
  • Weighted Mean Difference
  • Elective Colorectal Surgery