Sartori A, Botteri E, Agresta F, Gerardi C, Vettoretto N, Arezzo A, Pisanu A, Di Saverio S, Campanelli G, Podda M
Department of General Surgery, Montebelluna Civil Hospital, ULSS 2 Marca Trevigiana, Montebelluna, Italy.
Department of General Surgery, Montichiari Hospital, Montichiari, Italy.
Hernia. 2021 Apr;25(2):501-521. doi: 10.1007/s10029-020-02262-y. Epub 2020 Jul 18.
Although many studies assessing enhanced recovery after surgery (ERAS) pathways in abdominal wall reconstruction (AWR) have recently demonstrated lower rates of postoperative morbidity and a decrease in postoperative length of stay compared to standard practice, the utility of ERAS in AWR remains largely unknown.
A systematic literature search for randomized and non-randomized studies comparing ERAS (ERAS +) pathways and standard protocols (Control) as an adopted practice for patients undergoing AWR was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and EMBASE databases. A predefined search strategy was implemented. The included studies were reviewed for primary outcomes: overall postoperative morbidity, abdominal wall morbidity, surgical site infection (SSI), and length of hospital stay; and for secondary outcome: operative time, estimated blood loss, time to discontinuation of narcotics, time to urinary catheter removal, time to return to bowel function, time to return to regular diet, and readmission rate. Standardized mean difference (SMD) was calculated for continuous variables and Odds Ratio for dichotomous variables.
Five non-randomized studies were included for qualitative and quantitative synthesis. 840 patients were allocated to either ERAS + (382) or Control (458). ERAS + and Control groups showed equivalent results with regard to the incidence of postoperative morbidity (OR 0.73, 95% CI 0.32-1.63; I= 76%), SSI (OR 1.17, 95% CI 0.43-3.22; I= 54%), time to return to bowel function (SMD - 2.57, 95% CI - 5.32 to 0.17; I= 99%), time to discontinuation of narcotics (SMD - 0.61, 95% CI - 1.81 to 0.59; I= 97%), time to urinary catheter removal (SMD - 2.77, 95% CI - 6.05 to 0.51; I= 99%), time to return to regular diet (SMD - 0.77, 95% CI - 2.29 to 0.74; I= 98%), and readmission rate (OR 0.82, 95% CI 0.52-1.27; I= 49%). Length of hospital stay was significantly shorter in the ERAS + compared to the Control group (SMD - 0.93, 95% CI - 1.84 to - 0.02; I= 97%).
The introduction of an ERAS pathway into the clinical practice for patients undergoing AWR may cause a decreased length of hospitalization. These results should be interpreted with caution, due to the low level of evidence and the high heterogeneity.
尽管最近许多评估腹壁重建（AWR）手术加速康复（ERAS）路径的研究表明，与传统做法相比，术后发病率较低且术后住院时间缩短，但ERAS在AWR中的效用在很大程度上仍不明确。
使用MEDLINE、Cochrane对照试验中央注册库、Scopus、科学网和EMBASE数据库，对比较ERAS（ERAS +）路径与标准方案（对照组）作为AWR患者采用的做法的随机和非随机研究进行系统文献检索。实施了预定义的检索策略。对纳入研究的主要结局进行评估：总体术后发病率、腹壁发病率、手术部位感染（SSI）和住院时间；以及次要结局：手术时间、估计失血量、停用麻醉剂时间、拔除尿管时间、恢复肠功能时间、恢复正常饮食时间和再入院率。对连续变量计算标准化均值差（SMD），对二分变量计算比值比。
纳入五项非随机研究进行定性和定量综合分析。840例患者被分配至ERAS +组（382例）或对照组（458例）。ERAS +组和对照组在术后发病率（OR 0.73，95%CI 0.32 - 1.63；I = 76%）、SSI（OR 1.17，95%CI 0.43 - 3.22；I = 54%）、恢复肠功能时间（SMD - 2.57，95%CI - 5.32至0.17；I = 99%）、停用麻醉剂时间（SMD - 0.61，95%CI - 1.81至0.59；I = 97%）、拔除尿管时间（SMD - 2.77，95%CI - 6.05至0.51；I = 99%）、恢复正常饮食时间（SMD - 0.77，95%CI - 2.29至0.74；I = 98%）和再入院率（OR 0.82，95%CI 0.52 - 1.27；I = 49%）方面显示出等效结果。与对照组相比，ERAS +组的住院时间显著缩短（SMD - 0.93，95%CI - 1.84至 - 0.02；I = 97%）。
将ERAS路径引入AWR患者的临床实践可能会缩短住院时间。由于证据水平低且异质性高，这些结果应谨慎解读。
