Application efficacy of fast track surgery concept in perioperative period of choledocholithotomy: a Meta-analysis

Abstract

Objective To investigate the application efficacy of fast track surgery (FTS) concept in the perioperative period of choledocholithotomy. Methods Relevant literatures about the application of FTS concept in the perioperative period of choledocholithotomy published before February 2016 were searched from PubMed, Cochrane Library database, Wanfang database, Chongqing Vip database and CNKI by computer. The searching keywords included fast recovery, accelerated recovery, fast track surgery, FTS, enhanced recovery after surgery, ERAS, common bile duct stone, exploration of common bile duct, biliary tract operation, billiary tract surgery, etc. FTS method was used in the perioperative period of choledocholithotomy in the FTS group, while conventional method was used in the control group. The incidence of postoperative complications, the first anal exhaust time, hospitalization expense and postoperative length of hospital stay were compared between two groups. Fixed or random effect model was utilized for Meta-analysis. Results A total of 10 literatures, consisting of 1 204 cases, 627 in the FTS group and 577 in the control group, were included in this study. Meta-analysis revealed that compared with the control group, the incidence of total postoperative complications in the FTS group was significantly decreased [RR=0.49, 95%CI (0.39, 0.60), P<0.05], the first anal exhaust time was significantly shorter [SMD=-1.65, 95%CI(-2.14, -1.17), P<0.05], the hospitalization expense was significantly reduced [SMD=-1.08, 95%CI (-1.28, -0.88), P<0.05)], and the postoperative length of hospital stay was significantly shorter [WMD =-2.94, 95%CI (-3.24, -2.63), P<0.05]. No patient died in either group. Conclusions Application of FTS concept in the perioperative period of choledocholithotomy can significantly reduce the incidence of postoperative complications and hospitalization expense, accelerate the postoperative recovery of the patients. Key words: Fast-track surgery; Choledocholithiasis; Meta-analysis; Postoperative complications; Comparative effectiveness research