Li Zhengyan, Zhao Qingchuan, Bai Bin, Ji Gang, Liu Yezhou
Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China.
World J Surg. 2018 Nov;42(11):3463-3473. doi: 10.1007/s00268-018-4656-0.
Enhanced recovery after surgery (ERAS) protocols or laparoscopic technique has been applied in various surgical procedures. However, the clinical efficacy of combination of the two methods still remains unclear. Thus, our aim was to assess the role of ERAS protocols in laparoscopic abdominal surgery.
We performed a systematic literature search in various databases from January 1990 to October 2017. The results were analyzed according to predefined criteria.
In the present meta-analysis, the outcomes of 34 comparative studies (15 randomized controlled studies and 19 non-randomized controlled studies) enrolling 3615 patients (1749 in the ERAS group and 1866 in the control group) were pooled. ERAS group was associated with shorter hospital stay (WMD - 2.37 days; 95% CI - 3.00 to - 1.73; P 0.000) and earlier time to first flatus (WMD - 0.63 days; 95% CI - 0.90 to - 0.36; P 0.000). Meanwhile, lower overall postoperative complication rate (OR 0.62; 95% CI 0.51-0.76; P 0.000) and less hospital cost (WMD 801.52 US dollar; 95% CI - 918.15 to - 684.89; P 0.000) were observed in ERAS group. Similar readmission rate (OR 0.73, 95% CI 0.52-1.03, P 0.070) and perioperative mortality (OR 1.33; 95% CI 0.53-3.34; P 0.549) were found between the two groups.
ERAS protocol for laparoscopic abdominal surgery is safe and effective. ERAS combined with laparoscopic technique is associated with faster postoperative recovery without increasing readmission rate and perioperative mortality.
术后加速康复（ERAS）方案或腹腔镜技术已应用于各种外科手术。然而，两种方法联合应用的临床疗效仍不明确。因此，我们的目的是评估ERAS方案在腹腔镜腹部手术中的作用。
我们在1990年1月至2017年10月期间对各种数据库进行了系统的文献检索。根据预先设定的标准对结果进行分析。
在本荟萃分析中，汇总了34项比较研究（15项随机对照研究和19项非随机对照研究）的结果，共纳入3615例患者（ERAS组1749例，对照组1866例）。ERAS组的住院时间较短（加权均数差-2.37天；95%可信区间-3.00至-1.73；P<0.000），首次排气时间较早（加权均数差-0.63天；95%可信区间-0.90至-0.36；P<0.000）。同时，ERAS组的总体术后并发症发生率较低（比值比0.62；95%可信区间0.51-0.76；P<0.000），住院费用较少（加权均数差801.52美元；95%可信区间-918.15至-684.89；P<0.000）。两组的再入院率（比值比0.73，95%可信区间0.52-1.03，P=0.070）和围手术期死亡率（比值比1.33；95%可信区间0.53-3.34；P=0.549）相似。
腹腔镜腹部手术的ERAS方案是安全有效的。ERAS与腹腔镜技术相结合可使术后恢复更快，且不增加再入院率和围手术期死亡率。
