School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
School of Preclinical Medicine, Chengdu University, Chengdu, China.
PLoS One. 2023 Sep 21;18(9):e0291835. doi: 10.1371/journal.pone.0291835. eCollection 2023.
Enhanced recovery after surgery (ERAS) has become extensively practiced and has shown encouraging benefits. Within recent years, ERAS has also been increasingly performed in chronic rhinosinusitis (CRS) patients undergoing endoscopic sinus surgery (ESS). However, the actual efficacy of ERAS in CRS patients undergoing ESS is not completely clear, and the related evidence remains weak. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of ERAS in the perioperative management of CRS patients receiving ESS.
We searched randomized controlled trials in PubMed, Web of Science, EMBASE, Cochrane CENTRAL, Ovid, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, Wanfang, and VIP Database up to February 2023, to analyze the effectiveness and safety of ERAS in ESS perioperative management of CRS patients. We appraised the methodological quality in the included RCTs using the Cochrane Collaboration tool and assessed the quality of evidence with the Recommendations Assessment, Development and Evaluation (GRADE) tool. Meta-analysis, subgroup analysis, and sensitivity analysis were carried out with the the software Review Manager 5.3 and Stata 12.0. In addition, potential publication bias was detected by Begg's test, Egger's test, and funnel plot test.
Twenty-eight studies involving 2636 patients were included within this study. In comparison with the standard care (SC) group, the ERAS group had the advantages in the following aspects: length of stay (MD = -2.50, 95%CI: -3.04 to -1.97), pain scores (MD = -1.07, 95%CI: -1.46 to -0.67), anxiety score (SMD = -2.13, 95%CI: -2.83 to -1.44), depression score (SMD = -2.42, 95%CI: -3.13 to -1.71), hospitalization expenses, and quality of life. At the same time, the ERAS group presented a markedly lower incidence of adverse events in comparison to the SC group, such as overall complications (RR = 0.28, 95%CI:0.20 to 0.41), postoperative nausea and vomiting (RR = 0.33, 95%CI:0.21 to 0.50), facial edema (RR = 0.20, 95%CI:0.11 to 0.38), low back pain (RR = 0.28, 95%CI:0.16 to 0.49), urinary retention (RR = 0.12, 95%CI:0.05 to 0.30) and haemorrhage (RR = 0.19, 95%CI:0.07 to 0.55).
The results showed that the ERAS protocol is effective and safe in CRS patients who undergo ESS. However, Due to the limited overall methodological quality included studies, caution should be exercised in the interpretation of the results. More high-quality, multiple-centre, and large-sample studies are in demand in the future to further validate its clinical efficacy.
加速康复外科（ERAS）已经得到广泛应用，并显示出令人鼓舞的益处。近年来，ERAS 也越来越多地应用于接受内镜鼻窦手术（ESS）的慢性鼻-鼻窦炎（CRS）患者。然而，ERAS 在接受 ESS 的 CRS 患者中的实际疗效并不完全清楚，相关证据仍然薄弱。本系统评价和荟萃分析旨在评估 ERAS 在接受 ESS 的 CRS 患者围手术期管理中的有效性和安全性。
我们检索了 PubMed、Web of Science、EMBASE、Cochrane 中心、Ovid、中国知网、中国生物医学文献数据库、万方和维普数据库，截至 2023 年 2 月，以分析 ERAS 在 CRS 患者 ESS 围手术期管理中的有效性和安全性。我们使用 Cochrane 协作工具评估纳入的 RCT 中的方法学质量，并使用推荐评估、制定和评估（GRADE）工具评估证据质量。使用 Review Manager 5.3 和 Stata 12.0 进行荟萃分析、亚组分析和敏感性分析。此外，通过 Begg 检验、Egger 检验和漏斗图检验检测潜在的发表偏倚。
本研究共纳入 28 项研究，涉及 2636 名患者。与标准护理（SC）组相比，ERAS 组在以下方面具有优势：住院时间（MD=-2.50，95%CI：-3.04 至-1.97）、疼痛评分（MD=-1.07，95%CI：-1.46 至-0.67）、焦虑评分（SMD=-2.13，95%CI：-2.83 至-1.44）、抑郁评分（SMD=-2.42，95%CI：-3.13 至-1.71）、住院费用和生活质量。同时，与 SC 组相比，ERAS 组的不良事件发生率明显较低，例如总体并发症（RR=0.28，95%CI：0.20 至 0.41）、术后恶心和呕吐（RR=0.33，95%CI：0.21 至 0.50）、面部水肿（RR=0.20，95%CI：0.11 至 0.38）、腰痛（RR=0.28，95%CI：0.16 至 0.49）、尿潴留（RR=0.12，95%CI：0.05 至 0.30）和出血（RR=0.19，95%CI：0.07 至 0.55）。
结果表明，ERAS 方案对接受 ESS 的 CRS 患者有效且安全。然而，由于纳入研究的总体方法学质量有限，在解释结果时应谨慎。未来需要更多高质量、多中心、大样本的研究进一步验证其临床疗效。
