Evaluating the impact of enhanced recovery after surgery protocols following emergency laparotomy – A systematic review and meta-analysis of randomised clinical trials

Abstract

IntroductionEnhanced recovery after surgery (ERAS) protocols are an evidence-based, multidisciplinary, and systematic approach to peri-operative care, which attempt to reduce the anticipated physiological strain on patients after major surgery. This meta-analysis of randomised clinical trials (RCTs) evaluated the impact of ERAS following emergency laparotomy versus standard care. MethodsA systematic review was performed as per PRISMA guidelines. Meta-analysis was performed using RevMan v5.4. ResultsSix RCTs involving 509 patients were included. Patients randomised to ERAS had reduced post-operative nausea and vomiting (PONV) (odds ratio (OR): 0.32, 95 ​% confidence interval (CI): 0.20–0.51), time to ambulation (mean difference (MD): 1.67, 95 ​% CI: −2.56 to −0.78) and bowel opening (MD: −1.26, 95 ​% CI: −2.03 to −0.49), length of stay (LOS) (MD: −2.92 95 ​% CI: −3.73 - - 2.10), pulmonary complications (OR: 0.43, 95 ​% CI: 0.24–0.75), surgical site (OR: 0.33 95 ​% CI: 0.2–0.50) and urinary tract infections (OR: 0.48 95 ​% CI: 0.19–1.16). ConclusionERAS successfully reduced patient recovery, LOS, and complications. ERAS protocols should be deployed, where feasible, for emergency laparotomy.