Zhang Anping, Lu Hao, Chen Fangfang, Wu You, Luo Liqiong, Sun Siyi
Anesthesia Surgery Department, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China.
Children's Heart Center, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China.
Transl Pediatr. 2021 Nov;10(11):3034-3045. doi: 10.21037/tp-21-457.
Enhanced recovery after surgery (ERAS), as a new concept in surgery, has dramatically changed the mode of perioperative treatment for children with acute appendicitis.
The retrieval strategy developed by the Cochrane Collaboration was conducted using the CNKI database, Wanfang Medical Network, PubMed, EBSCO, Medline, and Cochrane database by combining subject headings and free words. A review of the randomized controlled trials on the use of the ERAS concept in the perioperative treatment of acute appendicitis in children was conducted between the establishment of the database and May 15, 2021. Keywords included enhanced recovery after surgery, fast track surgery, ERAS, FTS, child, infant, and appendicitis. The quality of the literature was evaluated according to the RevMan 5.3 software provided by the Cochrane Collaboration.
Five randomized controlled trials on ERAS in children with acute appendicitis were finally included. The heterogeneity of postoperative stay time was tested in 4 studies using continuous variables, with Chi-squared test (Chi) =221.52, degree of freedom (df) =3, I=99%>50%. An overall analysis using a random effects model showed that the ERAS group was significantly different compared to the control group [Z=5.26; mean difference (MD) =-1.65; 95% CI: -2.27 to -1.03; P<0.00001]. The heterogeneity of the readmission rate was tested in 5 studies using dichotomous variables, with Chi=5.11, df =3, I=41%<50%, P=0.91. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group [Z=0.80; odds ratio (OR) =1.16; 95% CI: 0.81 to 1.66; P=0.42]. The heterogeneity of the recurrence rate was tested in 4 studies using dichotomous variables, with Chi=3.73, df =3, I=20%<50%, P=0.29. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group (Z=1.14; OR =0.76; 95% CI: 0.47 to 1.22; P=0.26).
The results of the meta-analysis confirmed that perioperative application of the ERAS concept in children with acute appendicitis can promote the rehabilitation of children, reduce the postoperative stay time, and reduce the readmission rate and reoperation rate.
术后加速康复（ERAS）作为外科领域的一个新概念，极大地改变了儿童急性阑尾炎围手术期的治疗模式。
采用Cochrane协作网制定的检索策略，通过主题词与自由词相结合的方式，在知网数据库、万方医学网、PubMed、EBSCO、Medline及Cochrane数据库中进行检索。对数据库建立至2021年5月15日期间关于ERAS概念在儿童急性阑尾炎围手术期治疗中应用的随机对照试验进行综述。关键词包括术后加速康复、快速康复外科、ERAS、FTS、儿童、婴幼儿、阑尾炎。根据Cochrane协作网提供的RevMan 5.3软件对文献质量进行评价。
最终纳入5项关于儿童急性阑尾炎ERAS的随机对照试验。4项研究采用连续变量对术后住院时间的异质性进行检验，卡方检验（Chi）=221.52，自由度（df）=3，I=99%>50%。采用随机效应模型进行的总体分析显示，ERAS组与对照组相比有显著差异[Z=5.26；平均差（MD）=-1.65；95%置信区间（CI）：-2.27至-1.03；P<0.00001]。5项研究采用二分变量对再入院率的异质性进行检验，Chi=5.11，df =3，I=41%<50%，P=0.91。采用固定效应模型进行的总体分析显示，ERAS组与对照组之间无统计学显著差异[Z=0.80；比值比（OR）=1.
