Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of General Surgery, Watford General Hospital - West Hertfordshire Hospitals NHS Trust, UK.
Surgeon. 2018 Jun;16(3):183-192. doi: 10.1016/j.surge.2017.12.001. Epub 2018 Jan 12.
Fast track surgery has been implemented in colorectal procedures during the last decade and is accompanied by significant improvement in patient outcomes during the early postoperative period. However, to date, its adoption in upper gastrointestinal surgery remains a matter of debate. In this context, we aimed to summarize the existing evidence in the international literature.
We searched Medline, Scopus, ClinicalTrials.gov and Cochrane Central Register databases for published randomized controlled trials. The meta-analysis was performed with the RevMan 5.3.5 software.
Thirty studies were finally included in the present meta-analysis. The post-operative morbidity was not influenced by the implementation of fast track surgery (FTS) (OR 0.84, 95% CI 0.64-1.09). However, in cases treated with laparoscopic surgery fast track surgery seemed to reduce morbidity by 50% (p = .006). The overall mortality of patients was low in the majority of included studies and was not influenced by fast track surgery (OR 1.12, 95% CI 0.50-2.52). The duration of postoperative hospitalization was significantly reduced with the adoption of FTS (MD -2.24, 95% CI -2.63 to -1.85 days). Concurrently, the overall cost was significantly reduced in cases treated with FTS (MD -982.30, 95% CI -1367.68 to -596.91 U.S dollars).
According to the findings of our meta-analysis suggest that FTS seems to be safe in patients undergoing upper gastrointestinal surgery and reduce both the days of postoperative hospitalization and the overall cost. This observation should be taken into account in future recommendations to enhance the implementation of FTS protocols in current clinical practice.
快速康复外科在过去十年中已应用于结直肠手术，并且在术后早期患者转归方面取得了显著改善。然而，迄今为止，其在上消化道手术中的应用仍然存在争议。在此背景下，我们旨在总结国际文献中的现有证据。
我们检索了 Medline、Scopus、ClinicalTrials.gov 和 Cochrane 中央注册数据库中已发表的随机对照试验。采用 RevMan 5.3.5 软件进行荟萃分析。
最终有 30 项研究纳入本荟萃分析。快速康复外科的应用并未影响术后发病率（OR 0.84，95%CI 0.64-1.09）。然而，在接受腹腔镜手术治疗的患者中，快速康复外科似乎使发病率降低了 50%（p=0.006）。纳入研究中的大多数患者总体死亡率较低，且不受快速康复外科的影响（OR 1.12，95%CI 0.50-2.52）。采用快速康复外科可显著缩短术后住院时间（MD -2.24，95%CI -2.63 至-1.85 天）。同时，采用快速康复外科可显著降低总费用（MD -982.30，95%CI -1367.68 至-596.91 美元）。
根据荟萃分析结果，快速康复外科似乎在上消化道手术患者中是安全的，可缩短术后住院时间并降低总费用。这一观察结果应在未来的建议中加以考虑，以促进快速康复外科方案在当前临床实践中的实施。
