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Enhanced Recovery After Surgery (ERAS®) in Individuals with Diabetes: A Systematic Review

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Abstract

Background

Prevalence of diabetes in surgical patients is 10–40%. It is well recognized that they have higher rates of complications, and longer stays in hospital compared to patients without diabetes. Enhanced recovery after surgery (ERAS) is an evidence-based multimodal surgical care pathway that improves postoperative complications and length of stay in patients without diabetes. This review evaluates the evidence on whether individuals with diabetes would benefit from ERAS implementation.

Methods

MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE searched with no language restrictions applied. Conference proceedings and bibliographies were reviewed. Experts in the field were contacted, and www.clinicaltrials.gov searched for ongoing trials.

Selection criteria

Randomized controlled trials (RCT) looking at individuals with diabetes undergoing surgery randomized to ERAS® or conventional care. Non-randomized controlled trials, controlled before–after studies, interrupted time series, and cohort studies with concurrent controls were also considered. Two authors independently screened studies.

Results

The electronic search yielded 437 references. After removing duplicates, 376 were screened for eligibility. Conference proceedings and bibliographies identified additional references. Searching www.clinicaltrials.gov yielded 59 references. Contacting experts in the field identified no further studies. Fourteen full articles were assessed and subsequently excluded for the following reasons: used an intervention other than ERAS®, did not include patients with diabetes, or used an uncontrolled observational design.

Conclusions

To date, the effects of ERAS® on patients with diabetes have not been rigorously evaluated. This review highlights the lack of evidence in this area and provides guidance on design for future studies.

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Acknowledgements

We would like to thank Linda Slater, librarian at the University of Alberta, for her assistance in developing the search strategy for this review.

Authors’ contributions

Authors who contributed to the development of this review’s strategy, design, and analysis include ZA, FM, LG, and PS. The two independent reviewers were ZA and ML; FM was the third reviewer who resolved any disagreement. Additional expert opinion on ERAS in reviewing the manuscript was provided by LG. All authors reviewed and agreed on the final manuscript prior to submission.

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Authors and Affiliations

  1. Department of Medicine, University of Alberta, Edmonton, Canada

    Zaina Albalawi, Leah Gramlich, Peter Senior & Finlay A. McAlister

  2. Department of Surgery, University of Alberta, Edmonton, Canada

    Michael Laffin

  3. Endocrinology and Metabolism, Alberta Health Services, Edmonton, Canada

    Zaina Albalawi

  4. Gastroenterology, University of Alberta, Edmonton, Canada

    Leah Gramlich

  5. Endocrinology and Metabolism, University of Alberta, Edmonton, Canada

    Peter Senior

  6. General Internal Medicine, University of Alberta, Edmonton, Canada

    Finlay A. McAlister

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  1. Zaina Albalawi
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  2. Michael Laffin
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Correspondence to Zaina Albalawi.

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Albalawi, Z., Laffin, M., Gramlich, L. et al. Enhanced Recovery After Surgery (ERAS®) in Individuals with Diabetes: A Systematic Review. World J Surg 41, 1927–1934 (2017). https://doi.org/10.1007/s00268-017-3982-y

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