Almaski Ibrahim Ezuddin M, Alalwani Yazan Jumah, Alshammari Reem Salem, Alassiri Rayyan Mohammed A, Jathmi Salman Ahmed S, Alhadi Aishah Mohammed, Alzahrani Amal Saleh, Alzahrani Mohammed Abdulwahed, Azzam Ahmed Y, Maani Tareq A
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
College of Medicine, Northern Border University, Arar, Saudi Arabia.
Metabol Open. 2025 Jun 14;27:100376. doi: 10.1016/j.metop.2025.100376. eCollection 2025 Sep.
Enhanced recovery after surgery (ERAS) protocols are evidence-based care improvement processes designed to minimize and reduce the negative physiological consequences of surgery. While previous studies have investigated ERAS in bariatric surgery, none have evaluated which specific components contribute most significantly to improved outcomes.
We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. Six randomized controlled trials (RCTs) with total of 740 patients comparing ERAS protocols to standard care in bariatric surgery were included. We conducted component-specific meta-regression analysis of 14 individual ERAS elements, dose-response analysis across three implementation levels (low: ≤4 components, medium: 5-8 components, high: ≥9 components), and component clustering to identify synergistic combinations. Meta-regression was used to determine the relative impact of individual components on recovery and safety outcomes.
Six RCTs including a total of 740 patients were included. Patients randomized to ERAS protocols have experienced significant reductions in nausea and vomiting (OR: 0.42, 95 % CI: 0.19-0.95, P-value = 0.040), intraoperative time (MD: 5.40, 95 % CI: 3.05-7.77, P-value<0.001), time to mobilization (MD: 3.78, 95 % CI: 5.46 to -2.10, P-value<0.001), intensive care unit length of stay (MD: 0.70, 95 % CI: 0.13-1.27, P-value = 0.020), total hospital stay (MD: 0.42, 95 % CI: 0.69 to -0.16, P-value = 0.002), and functional hospital stay (MD: 0.60, 95 % CI: 0.98 to -0.22, P-value = 0.002). Component-based analysis demonstrated that early mobilization, anti-emetic protocols, optimized anesthesia, and multimodal analgesia contributed most significantly to improved outcomes. We observed a clear dose-response relationship, with greater benefits in studies implementing more ERAS components.
ERAS protocols significantly improve recovery metrics following bariatric surgery, with certain components demonstrating greater impact than others. Early mobilization and anti-emetic protocols appear particularly beneficial, while the "Complete Recovery Bundle" demonstrates synergistic effects. We recommend a tiered implementation approach, prioritizing high-impact components, especially in resource-limited settings.
术后加速康复（ERAS）方案是基于证据的护理改进流程，旨在最小化并减少手术带来的负面生理影响。虽然先前的研究已对减重手术中的ERAS进行了调查，但尚无研究评估哪些特定组成部分对改善预后的贡献最为显著。
我们按照PRISMA 2020指南进行了系统评价和荟萃分析。纳入了六项随机对照试验（RCT），共740例患者，比较了减重手术中ERAS方案与标准护理。我们对14个单独的ERAS要素进行了特定组成部分的荟萃回归分析、跨三个实施水平（低：≤4个组成部分，中：5 - 8个组成部分，高：≥9个组成部分）的剂量反应分析以及组成部分聚类，以识别协同组合。荟萃回归用于确定各个组成部分对恢复和安全结局的相对影响。
纳入了六项RCT，共740例患者。随机分配至ERAS方案的患者在恶心和呕吐（比值比：0.42，95%置信区间：0.19 - 0.95，P值 = 0.040）、手术时间（平均差：5.40，95%置信区间：3.05 - 7.77，P值<0.001）、活动时间（平均差：3.78，95%置信区间：5.46至 -2.10，P值<0.001）、重症监护病房住院时间（平均差：0.70，95%置信区间：0.13 - 1.27，P值 = 0.020）、总住院时间（平均差：0.42，95%置信区间：0.69至 -0.16，P值 = 0.002）和有效住院时间（平均差：0.60，95%置信区间：0.98至 -0.22，P值 = 0.002）方面均有显著降低。基于组成部分的分析表明，早期活动、抗呕吐方案、优化麻醉和多模式镇痛对改善预后的贡献最为显著。我们观察到了明显的剂量反应关系，在实施更多ERAS组成部分的研究中获益更大。
ERAS方案显著改善了减重手术后的恢复指标，某些组成部分的影响比其他部分更大。早期活动和抗呕吐方案似乎特别有益，而“完全恢复套餐”显示出协同效应。我们建议采用分层实施方法，优先考虑高影响组成部分尤其是在资源有限的环境中。
