Ellwanger Maurício Prätzel, Ellwanger Manuela Pozza, Jardine Matheus Budahazi, Bramucci Victoria, Hammes Stephany Aparecida Pereira, Lopes Lucca Moreira, Munhoz Antônio Carlos Mattar
Universidade do Contestado, Mafra, Santa Catarina, Brazil.
Universidade do Contestado, Mafra, Santa Catarina, Brazil.
J Gastrointest Surg. 2025 Mar;29(3):101939. doi: 10.1016/j.gassur.2024.101939. Epub 2025 Jan 2.
The Enhanced Recovery After Surgery (ERAS) protocol represents an advancement in perioperative care to reduce surgical stress and accelerate recovery. This meta-analysis aimed to evaluate the effectiveness of ERAS in pancreatic surgery and to assess the effect of the ERAS protocol vs conventional hospital care on postoperative outcomes, including length of stay (LOS) in the hospital, hospital costs, readmission rates, and infection rates in patients undergoing pancreatic surgery.
A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant RCTs. Data were extracted and analyzed using a random effects model. Statistical analyses were performed using RStudio.
A total of 7 RCTs involving 731 patients were included. The meta-analysis showed a statistically significant reduction in LOS by 2.49 days (mean difference, -2.49; 95% CI, -4.20 to -0.79; P <.01) with considerable heterogeneity (I = 86%). Hospital costs were significantly reduced (standardized mean difference, -0.36; 95% CI, -0.65 to -0.06; P =.02) with moderate heterogeneity (I = 52%). The readmission and infection rates showed no statistically significant differences between the ERAS and control groups. The Egger test indicated no significant publication bias.
The ERAS protocol significantly reduced LOS and hospital costs in patients who underwent pancreatic surgery. Our findings support the implementation of ERAS protocols to enhance recovery and optimize outcomes. To the best of our knowledge, our study is the first to demonstrate these results using an RCT-only meta-analysis approach in pancreatic surgery, highlighting the value of ERAS in improving perioperative care.
术后加速康复（ERAS）方案代表了围手术期护理的一项进步，旨在减轻手术应激并加速康复。本荟萃分析旨在评估ERAS在胰腺手术中的有效性，并评估ERAS方案与传统医院护理相比对术后结局的影响，包括胰腺手术患者的住院时间（LOS）、住院费用、再入院率和感染率。
按照系统评价和荟萃分析的首选报告项目指南，对随机对照试验（RCT）进行系统评价和荟萃分析。检索了PubMed、Cochrane对照试验中央注册库和Embase，以识别相关的RCT。使用随机效应模型提取和分析数据。使用RStudio进行统计分析。
共纳入7项RCT，涉及731例患者。荟萃分析显示，LOS在统计学上显著缩短2.49天（平均差，-2.49；95%CI，-4.20至-0.79；P<.01），异质性较大（I=86%）。住院费用显著降低（标准化平均差，-0.36；95%CI，-0.65至-0.06；P=.02），异质性中等（I=52%）。ERAS组和对照组之间的再入院率和感染率在统计学上无显著差异。Egger检验表明无显著的发表偏倚。
ERAS方案显著缩短了胰腺手术患者的LOS和住院费用。我们的研究结果支持实施ERAS方案以促进康复并优化结局。据我们所知，我们的研究是首次在胰腺手术中使用仅基于RCT的荟萃分析方法证明这些结果，突出了ERAS在改善围手术期护理方面的价值。
