Foster Lacey, Foppiani Jose, Patel Armaan, Brady Kai, Adams Alynah J, Choudry Umar, Lin Samuel J
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Plastic and Reconstructive Surgery, University of Minnesota, MN, USA.
J Plast Reconstr Aesthet Surg. 2025 Apr;103:273-281. doi: 10.1016/j.bjps.2025.01.072. Epub 2025 Feb 4.
Enhanced recovery after surgery (ERAS) protocols, introduced in 1997, are evidence-based strategies designed to reduce postoperative stress and improve recovery through a multidisciplinary approach. This systematic review evaluated the use of ERAS in plastic surgery, focusing on opioid use, pain management, hospital stay, and patient outcomes.
A literature search in PubMed/MEDLINE and Web of Science was conducted up to May 9, 2024, identifying 239 studies on ERAS in plastic surgery. Seventeen studies met the inclusion criteria, and 9 studies involving 1228 patients were included. Outcomes assessed were narcotic use, pain scores, hospital stay, and complications. Quality was assessed using the National Institute of Health (NIH) tool.
Among the 9 studies, 4 were included in a meta-analysis (600 participants). ERAS protocols were associated with a significantly shorter hospital stay (mean difference: -0.58 days, P = 0.003) with no heterogeneity. Opioid use decreased (mean difference: -85.5 morphine milligram equivalents [MME]), although the results were uncertain due to high heterogeneity (I² = 99.9). ERAS also showed lower pain scores within 24 h postsurgery, but with considerable variability (mean difference: -1.56, P = 0.27).
ERAS protocols reduce opioid consumption and hospital stays while maintaining or improving patient satisfaction in plastic surgery. Despite risks such as increased bleeding, the benefits suggest that ERAS enhances recovery. Future research should optimize protocols and address regional implementation challenges.
1997年引入的术后加速康复（ERAS）方案是基于证据的策略，旨在通过多学科方法减轻术后应激并促进康复。本系统评价评估了ERAS在整形手术中的应用，重点关注阿片类药物使用、疼痛管理、住院时间和患者结局。
截至2024年5月9日，在PubMed/MEDLINE和Web of Science中进行文献检索，共识别出239项关于整形手术中ERAS的研究。17项研究符合纳入标准，纳入了9项涉及1228例患者的研究。评估的结局包括麻醉药物使用、疼痛评分、住院时间和并发症。使用美国国立卫生研究院（NIH）工具评估质量。
在9项研究中，4项纳入了荟萃分析（600名参与者）。ERAS方案与显著缩短的住院时间相关（平均差异：-0.58天，P = 0.003），且无异质性。阿片类药物使用减少（平均差异：-85.5吗啡毫克当量[MME]），尽管由于高度异质性（I² = 99.9）结果尚不确定。ERAS在术后24小时内也显示出较低的疼痛评分，但存在相当大的变异性（平均差异：-1.56，P = 0.27）。
ERAS方案在整形手术中减少了阿片类药物的消耗和住院时间，同时维持或提高了患者满意度。尽管存在出血增加等风险，但益处表明ERAS可促进康复。未来的研究应优化方案并应对区域实施挑战。
