Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
Gynecol Oncol. 2021 Apr;161(1):46-55. doi: 10.1016/j.ygyno.2020.12.035. Epub 2020 Dec 30.
To assess the benefit of Enhanced Recovery After Surgery (ERAS) on length of stay (LOS), postoperative complications, 30-day readmission, and cost in gynecologic oncology.
A systematic literature search was performed in MEDLINE, EMBASE, Cochrane Register of Controlled Trials, and Web of Science for all peer-reviewed cohort studies and controlled trials on ERAS involving gynecologic oncology patients. Abstracts, commentaries, non-controlled studies, and studies without specific data on gynecologic oncology patients were excluded. Meta-analysis was performed on the primary endpoint of LOS. Subgroup analyses were performed based on risk of bias of the studies included, number of ERAS elements, and ERAS compliance. Secondary endpoints were readmission rate, complications, and cost.
A total of 31 studies (6703 patients) were included: 5 randomized controlled trials, and 26 cohort studies. Meta-analysis of 27 studies (6345 patients) demonstrated a decrease in LOS of 1.6 days (95% confidence interval, CI 1.2-2.1) with ERAS implementation. Meta-analysis of 21 studies (4974 patients) demonstrated a 32% reduction in complications (OR 0.68, 95% CI 0.55-0.83) and a 20% reduction in readmission (OR 0.80, 95% CI 0.64-0.99) for ERAS patients. There was no difference in 30-day postoperative mortality (OR 0.61, 95% CI 0.23-1.6) for ERAS patients compared to controls. No difference in the odds of complications or reduction in LOS was observed based on number of included ERAS elements or reported compliance with ERAS interventions. The mean cost savings for ERAS patients was $2129 USD (95% CI $712 - $3544).
ERAS protocols decrease LOS, complications, and cost without increasing rates of readmission or mortality in gynecologic oncology surgery. This evidence supports implementation of ERAS as standard of care in gynecologic oncology.
评估增强术后康复（ERAS）对妇科肿瘤患者住院时间（LOS）、术后并发症、30 天再入院率和成本的影响。
对 MEDLINE、EMBASE、Cochrane 对照试验注册库和 Web of Science 中的所有同行评议队列研究和涉及妇科肿瘤患者的 ERAS 对照试验进行了系统的文献检索。排除摘要、评论、非对照研究以及没有妇科肿瘤患者具体数据的研究。对 LOS 这一主要结局进行了荟萃分析。根据纳入研究的偏倚风险、ERAS 要素的数量和 ERAS 的依从性进行了亚组分析。次要结局为再入院率、并发症和成本。
共纳入 31 项研究（6703 例患者）：5 项随机对照试验和 26 项队列研究。对 27 项研究（6345 例患者）的荟萃分析显示，实施 ERAS 可使 LOS 减少 1.6 天（95%置信区间，CI 1.2-2.1）。对 21 项研究（4974 例患者）的荟萃分析显示，ERAS 患者的并发症减少 32%（OR 0.68，95%CI 0.55-0.83），再入院率降低 20%（OR 0.80，95%CI 0.64-0.99）。与对照组相比，ERAS 患者术后 30 天死亡率无差异（OR 0.61，95%CI 0.23-1.6）。基于纳入的 ERAS 要素数量或报告的 ERAS 干预措施的依从性，并发症的发生几率或 LOS 的减少均无差异。ERAS 患者的平均成本节约为 2129 美元（95%CI 712-3544）。
在妇科肿瘤手术中，ERAS 方案可降低 LOS、并发症和成本，而不会增加再入院率或死亡率。这一证据支持将 ERAS 作为妇科肿瘤护理标准的实施。
