Enhanced recovery after abdominal wall reconstruction: a systematic review and meta-analysis
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and Other Interventional Techniques
REVIEW ARTICLE
Enhanced recovery after abdominal wall reconstruction: a systematic review and meta‑analysis Lise Lode1 · Erling Oma2 · Nadia A. Henriksen1 · Kristian K. Jensen2 Received: 28 April 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Enhanced recovery after surgery (ERAS) are evidence-based protocols associated with improved patient outcomes. The use of ERAS pathways is well documented in various surgical specialties. The aim of this systematic review and meta-analysis was to examine the efficacy of ERAS protocols in patients undergoing abdominal wall reconstruction (AWR). Methods This systematic review and meta-analysis were reported according to PRISMA and MOOSE guidelines. The databases PubMed, EMBASE, CINAHL, Web of Science and Cochrane Library were searched for original studies comparing ERAS with standard care in patients undergoing AWR. The primary outcome was length of stay (LOS) and secondary outcomes were readmission and surgical site infection (SSI) and/or surgical site occurrences (SSO). Results Five studies were included in the meta-analysis. All were retrospective cohort studies including 453 patients treated according to ERAS protocols, and 494 patients treated according to standard care. The meta-analysis demonstrated that patients undergoing AWR managed with ERAS had a mean 0.89 days reduction in LOS compared with patients treated with standard care (95% CI − 1.70 to − 0.07 days, p = 0.03). There was no statistically significant difference in readmission rate (OR 1.00, 95% CI 0.53 to 1.87, p = 1.00) or SSI/SSO (OR 1.19, 95% CI 0.67 to 2.11, p = 0.56) between groups. Conclusions The use of ERAS in patients undergoing AWR was found to significantly reduce LOS without increasing the readmission rate or SSI/SSO. Based on the existing literature, ERAS protocols should be implemented for patients undergoing AWR. Keywords ERAS · Ventral hernia repair · Postoperative complications · Recovery · Length of stay Enhanced recovery after surgery (ERAS) represents multimodal protocols to improve surgical outcomes and enhance the value of care [1]. The concept of fast-track surgery pathways was introduced in the mid-1990s as a care-bundle of evidence-based interventions to improve postoperative outcomes after surgery [2, 3]. In addition to enhanced patient outcomes, ERAS pathways are intended to provide a more economical and efficient utilization of the health care system [4]. ERAS include evidence-based protocols for preoperative, perioperative and postoperative measures with the goal of minimizing surgical stress and thus improve recovery and decrease the risk of organ dysfunction and postoperative * Lise Lode [email protected] 1
Department of Surgery, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
2
complications [1]. The approach is well documented in several surgical specialtie
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