Abu-Shawer Osama, E'mar Abdel-Rahman, Jaber Abdel-Rahman, Tailakh Shatha, Abu-Shawer Amer, Al-Haddadin Caroline
Anesthesiology and Perioperative Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.
Departement of Pediatrics, Cleveland Clinic Foundation, Cleveland, Ohio, United States.
Avicenna J Med. 2025 May 6;15(2):80-85. doi: 10.1055/s-0045-1808072. eCollection 2025 Apr.
The Enhanced Recovery After Surgery (ERAS) protocols are a set of steps taken before, during, and after surgery to improve patient care and outcomes. While ERAS is well known for its benefits in various surgeries, its application in pediatric cardiac surgery is relatively new. With the recent emergence of studies on its implementation in pediatric cardiac surgery, this study is the first to systematically review the current evidence on the efficacy of ERAS in the field.
A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently searched PubMed, Cochrane, Google Scholar, Web of Science, Embase, and Scopus databases for comparative studies with control groups that described the use of ERAS in all types of pediatric cardiac surgeries from 2000 to 2024. The data collected included study design, patient demographics, elements of the ERAS protocols, and postoperative outcomes. The random-effects model was used to calculate the pooled odds ratios (ORs) and mean differences (MDs) with the corresponding confidence intervals (CIs) for proportional and continuous variables, respectively.
Five studies, involving 1,008 patients, were included in the final analysis: three randomized controlled trials (RCTs), one retrospective cohort, and one case-control study. The ERAS protocols were applied in 430 (43%) patients, and standard perioperative care was applied in 578 (57%) patients. The analysis revealed that implementing the ERAS protocol significantly reduced ICU length of stay ( = 98.26%; MD = -1.441; 95% CI: -2.610 to -0.273; = 0.016). The ERAS group had a comparable rate of postoperative complications to the standard care group ( = 15.3%; OR: 0.889; 95% CI: 0.622-1.269; = 0.516).
The ERAS protocols in pediatric cardiac surgery appear to be safe and effective in improving certain short-term outcomes. However, evidence is limited due to the small number of studies. Further multicenter RCTs that fully incorporate the ERAS protocol elements and assess both immediate and long-term outcomes are needed.
术后加速康复（ERAS）方案是在手术前、手术中和手术后采取的一系列措施，以改善患者护理和预后。虽然ERAS在各种手术中的益处广为人知，但其在小儿心脏手术中的应用相对较新。随着最近关于其在小儿心脏手术中实施的研究不断涌现，本研究首次系统回顾了该领域中ERAS疗效的现有证据。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行Meta分析。两名研究者独立检索了PubMed、Cochrane、谷歌学术、科学网、Embase和Scopus数据库，以查找有对照组的比较研究，这些研究描述了2000年至2024年期间ERAS在所有类型小儿心脏手术中的应用。收集的数据包括研究设计、患者人口统计学、ERAS方案的要素以及术后结果。随机效应模型分别用于计算比例变量和连续变量的合并比值比（OR）和平均差（MD）以及相应的置信区间（CI）。
最终分析纳入了五项研究，涉及1008例患者：三项随机对照试验（RCT）、一项回顾性队列研究和一项病例对照研究。430例（43%）患者应用了ERAS方案，578例（57%）患者接受了标准围手术期护理。分析显示，实施ERAS方案显著缩短了重症监护病房（ICU）住院时间（I² = 98.26%；MD = -1.441；95%CI：-2.610至-0.273；P = 0.016）。ERAS组术后并发症发生率与标准护理组相当（I² = 15.3%；OR：0.889；95%CI：0.622 - 1.269；P = 0.516）。
小儿心脏手术中的ERAS方案在改善某些短期预后方面似乎是安全有效的。然而，由于研究数量较少，证据有限。需要进一步开展充分纳入ERAS方案要素并评估近期和长期结果的多中心RCT。
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