The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials

Abstract

This study aimed to produce a comprehensive, up-to-date meta-analysis exploring the safety and efficacy of enhanced recovery programs after colorectal resection. Medline, Embase, and Cochrane database searches were performed for relevant studies published between January 1966 and April 2012. All randomized controlled trials on fast track (FT) colorectal surgery were reviewed systematically. The main end points were short-term morbidity, length of primary postoperative hospital stay, length of total postoperative stay, readmission rate, and mortality. Seven randomized controlled trials with 852 patients were included. The total length of hospital stay [mean difference (95% confidence interval), -1.88 (-2.91, -0.86), p = 0.0003] and total complication rates [relative risk (95% confidence interval), 0.69 (0.51, 0.93), p = 0.01] were significantly reduced in the enhanced recovery group. There was no statistically significant difference in readmission (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.52 to 1.53, p = 0.69) and mortality rates (RR 1.02; 95% CI 0.40 to 2.57, p = 0.97). Results suggested that enhanced recovery after surgery pathways can be able to reduce the length of stay and complication rates after major colorectal surgery without compromising patient safety. Future studies have to define the active elements in order to improve future fast track protocols.