Enhanced recovery after surgery protocols following emergency intra-abdominal surgery: a systematic review and meta-analysis

Tyler McKechnie; Léa Tessier; Victoria Archer; Lily Park; Dan Cohen; Brendan Levac; Sameer Parpia; Mohit Bhandari; Joanna Dionne; Cagla Eskicioglu

doi:10.1007/s00068-023-02387-6

Enhanced recovery after surgery protocols following emergency intra-abdominal surgery: a systematic review and meta-analysis

Eur J Trauma Emerg Surg. 2023 Nov 20. doi: 10.1007/s00068-023-02387-6. Online ahead of print.

Authors

Tyler McKechnie^{1

2}, Léa Tessier³, Victoria Archer^{1

2}, Lily Park^{1

2}, Dan Cohen^{2

4}, Brendan Levac¹, Sameer Parpia², Mohit Bhandari^{2

4}, Joanna Dionne^{2

3}, Cagla Eskicioglu^{5

6

7}

Affiliations

¹ Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
³ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
⁴ Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁵ Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. eskicio@mcmaster.ca.
⁶ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. eskicio@mcmaster.ca.
⁷ Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada. eskicio@mcmaster.ca.

PMID: 37985500
DOI: 10.1007/s00068-023-02387-6

Abstract

Purpose: The aim of this systematic review and meta-analysis was to evaluate whether Enhanced Recovery After Surgery (ERAS) protocols for patients undergoing emergency intra-abdominal surgery improve postoperative outcomes as compared to conventional care.

Methods: MEDLINE, EMBASE, WoS, CENTRAL, and Pubmed were searched from inception to December 2022. Articles were eligible if they were randomized controlled trials (RCT) or non-randomized studies comparing ERAS protocols to conventional care for patients undergoing emergency intra-abdominal surgery. The outcomes included postoperative length of stay (LOS), postoperative morbidity, prolonged postoperative ileus (PPOI), and readmission. An inverse variance random effects meta-analysis was performed. A risk of bias was assessed with Cochrane tools. Certainty of evidence was assessed with GRADE.

Results: After screening 1018 citations, 20 studies with 1615 patients in ERAS programs and 1933 patients receiving conventional care were included. There was a reduction in postoperative LOS in the ERAS group for patients undergoing upper gastrointestinal (GI) surgery (MD3.35, 95% CI 2.52-4.17, p < 0.00001) and lower GI surgery (MD2.80, 95% CI 2.62-2.99, p < 0.00001). There was a reduction in postoperative morbidity in the ERAS group for patients undergoing upper GI surgery (RR0.56, 95% CI 0.30-1.02, p = 0.06) and lower GI surgery (RR 0.66, 95%CI 0.52-0.85, p = 0.001). In the upper and lower GI subgroup, there were nonsignificant reductions in PPOI in the ERAS groups (RR0.59, 95% CI 0.30-1.17, p = 0.13; RR0.49, 95% CI 0.21-1.14, p = 0.10). There was a nonsignificant increased risk of readmission in the ERAS group (RR1.60, 95% CI 0.57-4.50, p = 0.50).

Conclusion: There is low-to-very-low certainty evidence supporting the use ERAS protocols for patients undergoing emergency intra-abdominal surgery. The currently available data are limited by imprecision.

Keywords: Colorectal surgery; Emergency surgery; Enhanced recovery after surgery; Enhanced recovery programs; General surgery.

Publication types

Review