Enhanced recovery after surgery programs in the perioperative safety of pancreatic surgery: a Meta-analysis

Abstract

Objective To evaluate the safety of enhanced recovery after surgery (ERAS) programs in pancreas surgery. Methods A computer search was performed on databases which included the Wanfang, CNKI, VIP, PubMed, Cochrane Library, Embase and Sciencedirect for randomized controlled trials or case-control studies on ERAS programs in pancreatic surgery published between January 1995 and August 2017. Two researchers independently evaluated the quality of the studies which met the inclusion criteria and performed a meta-analysis using the RevMan5.3.5 software. Results Four randomized controlled trials and twenty one case-control studies which included 4 063 patients entered into the meta-analysis. These patients included the ERAS group (n=2 052) and the control group (n=2 011 who underwent traditional perioperative management). Compared with the control group, the ERAS group had a lower postoperative complication rate (OR=0.57, 95%CI: 0.45~0.71, P<0.05), a lower delayed gastric emptying rate (OR=0.46, 95%CI: 0.37~0.59, P<0.05), a lower abdominal infection rate (OR=0.68, 95%CI: 0.53~0.88, P<0.05), a shorter hospital stay (WMD=-4.86, 95%CI: -6.10~-3.62, P<0.05) and intensive care stay (WMD=-1.04, 95%CI: -2.01~-0.08, P<0.05). No significant differences existed in the mortality, readmission and postoperative pancreatic fistula rates between the two groups. Conclusion Perioperative implementation of ERAS programs was safe and effective in pancreatic surgery, and decreased postoperative complication rates and promoted recovery. Key words: Pancreatic surgery; Enhanced recovery after surgery; Perioperative safety; Postoperative complication; Meta-analysis