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Meta-analysis of Enhanced Recovery After Surgery (ERAS) Protocols in Emergency Abdominal Surgery

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World Journal of Surgery Aims and scope Submit manuscript

Abstract

Objectives

To evaluate enhanced recovery after surgery (ERAS) protocols in emergency abdominal surgery.

Methods

The electronic data sources were explored to capture all studies that evaluated the impact of ERAS protocols in patients who underwent emergency abdominal surgery. The quality of randomised and non-randomised studies was evaluated by the Cochrane tool and the Newcastle–Ottawa scale, respectively. Random or fixed effects modelling were utilised as indicated.

Results

Six comparative studies, enrolling 1334 patients, were eligible. ERAS protocols resulted in shorter post-operative time to first flatus (mean difference: −1.40, P < 0.00001), time to first defecation (mean difference: −1.21, P = 0.02), time to first oral liquid diet (mean difference: −2.30, P < 0.00001), time to first oral solid diet (mean difference: −2.40, P < 0.00001) and length of hospital stay (mean difference: −3.09, −2.80, P < 0.00001). ERAS protocols also resulted in lower risks of total complications (odds ratio: 0.50, P < 0.00001), major complications (odds ratio: 0.60, P = 0.0008), pulmonary complications (odds ratio: 0.38, P = 0.0003), paralytic ileus (odds ratio: 0.53, 0.88, P = 0.01) and surgical site infection (odds ratio: 0.39, P = 0.0001). Both ERAS and non-ERAS protocols resulted in similar risk of 30-day mortality (risk difference: −0.00, P = 0.94), need for re-admission (risk difference: −0.01, P = 0.50) and need for re-operation (odds ratio: 0.83, P = 0.50).

Conclusions

Although ERAS protocols are commonly used in elective settings, they are associated with favourable outcomes in emergency settings as indicated by reduced post-operative complications, accelerated recovery of bowel function and shorter post-operative hospital stay without increasing need for re-admission or re-operation. There should be an effort to incorporate ERAS protocols into emergency abdominal surgery settings.

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References

  1. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24(3):466–477

    Article  CAS  Google Scholar 

  2. Watt DG, McSorley ST, Horgan PG, McMillan DC (2015) Enhanced recovery after surgery: which components, if any, impact on the systemic inflammatory response following colorectal surgery? A systematic review. Medicine (Baltimore) 94(36):e1286

    Article  CAS  Google Scholar 

  3. Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbølle P, Hendel HW et al (2002) Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89:446–453

    Article  CAS  Google Scholar 

  4. Barbieri A, Vanhaecht K, Van Herck P, Sermeus W, Faggiano F, Marchisio S et al (2009) Effects of clinical pathways in the joint replacement: a meta-analysis. BMC Med 7:32

    Article  CAS  Google Scholar 

  5. Azhar RA, Bochner B, Catto J, Goh AC, Kelly J, Patel HD et al (2016) Enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and research needs. Eur Urol 70:176–187

    Article  Google Scholar 

  6. Arsalani-Zadeh R, ElFadl D, Yassin N, MacFie J (2011) Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg 98:181–196

    Article  CAS  Google Scholar 

  7. Hughes MJ, McNally S, Wigmore SJ (2014) Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford) 16:699–706

    Article  Google Scholar 

  8. Pisarska M, Małczak P, Major P, Wysocki M, Budzyński A, Pędziwiatr M (2017) Enhanced recovery after surgery protocol in oesophageal cancer surgery: systematic review and meta-analysis. PLoS ONE 12:e0174382

    Article  Google Scholar 

  9. de Groot JJ, Ament SM, Maessen JM, Dejong CH, Kleijnen JM, Slangen BF (2016) Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 95:382–395

    Article  Google Scholar 

  10. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  Google Scholar 

  11. Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C et al (2009) Consensus review of optimal perioperative care in colorectal surgery: enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144:961–969

    Article  Google Scholar 

  12. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/nos_manual.pdf. Accessed 19 Apr 2019

  13. Shang Y, Guo C, Zhang D (2018) Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer: a propensity score matching analysis. Medicine (Baltimore) 97(39):e12348

    Article  Google Scholar 

  14. Mohsina S, Shanmugam D, Sureshkumar S, Kundra P, Mahalakshmy T, Kate V (2018) Adapted ERAS pathway vs. standard care in patients with perforated duodenal ulcer—a randomized controlled trial. J Gastrointest Surg. J 22(1):107–116

    Article  Google Scholar 

  15. Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T et al (2017) Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg 17(1):18

    Article  Google Scholar 

  16. Wisely JC, Barclay KL (2016) Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients. ANZ J Surg 86(11):883–888

    Article  Google Scholar 

  17. Gonenc M, Dural AC, Celik F, Akarsu C, Kocatas A, Kalayci MU et al (2014) Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trial. Am J Surg 207(6):807–814

    Article  Google Scholar 

  18. Lohsiriwat V (2014) Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol 20(38):13950–13955

    Article  Google Scholar 

  19. Ji HB, Zhu WT, Wei Q, Wang XX, Wang HB, Chen QP (2018) Impact of enhanced recovery after surgery programs on pancreatic surgery: a meta-analysis. World J Gastroenterol 24(15):1666–1678

    Article  Google Scholar 

  20. Wang LH, Zhu RF, Gao C, Wang SL, Shen LZ (2018) Application of enhanced recovery after gastric cancer surgery: an updated meta-analysis. World J Gastroenterol 24(14):1562–1578

    Article  Google Scholar 

  21. Li L, Chen J, Liu Z, Li Q, Shi Y (2017) Enhanced recovery program versus traditional care after hepatectomy: a meta-analysis. Medicine (Baltimore) 96(38):e8052

    Article  Google Scholar 

  22. Pisarska M, Małczak P, Major P, Wysocki M, Budzyński A, Pędziwiatr M (2017) Enhanced recovery after surgery protocol in oesophageal cancer surgery: systematic review and meta-analysis. PLoS ONE 12(3):e0174382

    Article  Google Scholar 

  23. Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29(12):3443–3453

    Article  CAS  Google Scholar 

  24. Shuldham C (1999) A review of the impact of pre-operative education on recovery from surgery. Int J Nurs Stud 36:171–177

    Article  CAS  Google Scholar 

  25. Sethi A, Debbarma M, Narang N, Saxena A, Mahobia M, Tomar GS (2018) Impact of targeted preoperative optimization on clinical outcome in emergency abdominal surgeries: a prospective randomized trial. Anesth Essays Res 12:149–154

    Article  Google Scholar 

  26. Bilgin H (2017) Inadverdent perioperative hypothermia. Turk J Anaesthesiol Reanim 45:124–126

    Article  Google Scholar 

  27. Huddart S, Peden CJ, Swart M, McCormick B, Dickinson M, Mohammed MA et al (2015) Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy. Br J Surg 102:57–66

    Article  CAS  Google Scholar 

  28. Sapkota R, Bhandari RS (2013) Prophylactic nasogastric decompression after emergency laparotomy. JNMA J Nepal Med Assoc 52:437–442

    PubMed  Google Scholar 

  29. Lohsiriwat V (2016) Pelvic drain after colorectal anastomosis: useful or useless. Transl Cancer Res 5:S1404–S1407

    Article  Google Scholar 

  30. Klappenbach RF, Yazyi FJ, Alonso Quintas F, Horna ME, Alvarez Rodríguez J, Oría A (2013) Early oral feeding versus traditional postoperative care after abdominal emergency surgery: a randomized controlled trial. World J Surg 37:2293–2299. https://doi.org/10.1007/s00268-013-2143-1

    Article  PubMed  Google Scholar 

  31. Boden I, Sullivan K, Hackett C, Winzer B, Lane R, McKinnon M et al (2018) ICEAGE (Incidence of Complications following Emergency Abdominal surgery: Get Exercising): study protocol of a pragmatic, multicentre, randomised controlled trial testing physiotherapy for the prevention of complications and improved physical recovery after emergency abdominal surgery. World J Emerg Surg 13:29

    Article  Google Scholar 

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Funding

There were no funding resources for this study

Author information

Author notes

  1. Shahab Hajibandeh and Shahin Hajibandeh had equal contributions in this study proposing joined first authorship.

Authors and Affiliations

  1. Glan Clwyd Hospital, Rhyl, Denbighshire, UK

    Shahab Hajibandeh

  2. Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK

    Shahin Hajibandeh

  3. North Manchester General Hospital, Manchester, UK

    Victor Bill

  4. Manchester Royal Infirmary Hospital, Manchester, UK

    Thomas Satyadas

Authors
  1. Shahab Hajibandeh
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  2. Shahin Hajibandeh
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  3. Victor Bill
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  4. Thomas Satyadas
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Contributions

SH was the lead of the project and designed the study. SH and SH performed the statistical analyses required in this study and wrote the first draft of the article. All authors contributed to collection of data, revision of the first draft and approving the final version of the article

Corresponding author

Correspondence to Shahab Hajibandeh.

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Conflict of interest

All authors confirmed that they had no conflict of interest.

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Ethical approval was not required for this study.

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Appendix

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Search #1

enhance* near2 recovery

T, A, K

Search #2

ERAS

T, A, K

Search #3

Search #1 OR Search #2

Combined with OR

Search #4

emergency near2 surgery

T, A, K

Search #5

MeSH term: [laparotomy]

explode all trees

Search #6

emergency near2 laparotomy

T, A, K

Search #7

Search #4 OR Search #5 OR Search #6

Combined with OR

Search #8

Search #3 AND Search #7

Combined with AND

  1. T, A, K: titles, abstracts, keywords

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Hajibandeh, S., Hajibandeh, S., Bill, V. et al. Meta-analysis of Enhanced Recovery After Surgery (ERAS) Protocols in Emergency Abdominal Surgery. World J Surg 44, 1336–1348 (2020). https://doi.org/10.1007/s00268-019-05357-5

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  • DOI: https://doi.org/10.1007/s00268-019-05357-5

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