Safety and efficacy of enhanced recovery after surgery among patients undergoing percutaneous nephrolithotomy: a systematic review and meta-analysis

Liang Liu; Yu Xiao; Xiao Yue; Qiang Wang

doi:10.1097/JS9.0000000000001158

Safety and efficacy of enhanced recovery after surgery among patients undergoing percutaneous nephrolithotomy: a systematic review and meta-analysis

Int J Surg. 2024 Feb 13. doi: 10.1097/JS9.0000000000001158. Online ahead of print.

Authors

Liang Liu^{1

2}, Yu Xiao^{3

4}, Xiao Yue^{1

2}, Qiang Wang^{1

2}

Affiliations

¹ Department of Urology, Baoding No.1 Central Hospital, Baoding, Hebei, China.
² Prostate & Andrology Key Laboratory of Baoding, Baoding, Hebei, China.
³ Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China.
⁴ Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.

PMID: 38349202
DOI: 10.1097/JS9.0000000000001158

Abstract

Background: The enhanced recovery after surgery (ERAS) method has been widely used in surgery and anesthesia worldwide and has been applied to a wide range of surgical specialties, including colorectal surgery, gynecology, liver surgery, breast surgery, urology, and spinal surgery. An increasing number of studies have demonstrated its safety and efficacy in various fields. The safety and effectiveness of ERAS for percutaneous nephrolithotomy (PCNL) remain controversial. This study aimed to review the safety and effectiveness of ERAS for PCNL.

Methods: The Chinese National Knowledge Infrastructure (CNKI), Wan Fang, Chinese Biomedical Literature Service System (SinoMed), Chinese Science and Technology Journal Full Text Database (VIP), Cochrane Library, PubMed, Web of Science, and Embase databases were searched for eligible studies published until September 19, 2022. Outcome measures included postoperative hospital stay, total hospital stay, incidence of postoperative complications, stone-free rate (SFR), operative time, postoperative indwelling nephrostomy tube time, catheter encumbrance time, and nursing satisfaction. All analyses were performed using random effects or fixed effects models. Clinical heterogeneity was treated with subgroup, sensitivity, or descriptive analyses only when clinical heterogeneity was not excluded. Publication bias was assessed using funnel plots. Twenty-five studies (1,545 observational patients and 1,562 controls) were included.

Results: The ERAS group had a shorter postoperative hospital stay [WMD=-2.59, 95% CI=(-3.04, -2.14), P<0.001], total hospital stay [WMD=-2.59, 95% CI=(-3.04, -2.14), P<0.001], and lower complication rate [RR=0.36, 95% CI=(0.29, 0.43), P<0.001] than the control group. The ERAS group had a shorter surgery time [WMD=-3.57, 95% CI=(-5.88, -1.26), P=0.003], postoperative indwelling nephrostomy tube time [WMD=-1.94, 95% CI=(-2.69, -1.19), P<0.001], catheter encumbrance time [WMD=-2.65, 95% CI=(-4.83, -0.46), P=0.02], and higher satisfaction [RR=1.15, 95% CI=(1.05, 1.25), P=0.001] than the control group. The difference in the stone-free rate between the two groups was not statistically significant [RR=1.03, 95% CI=(0.97, 1.09), P=0.38], but the stone-free rate of the observation group (ERAS group) in each study was higher than that of the control group.

Conclusion: ERAS not only ensures the safety of PCNL but also promotes postoperative rehabilitation of patients (shorter surgery time, postoperative indwelling nephrostomy tube time, postoperative hospital time, and lower complication rate). At the same time, differences in the stone-free rate were not statistically significant, but the stone-free rate of ERAS in each study was higher than that of the usual care for PCNL patients.