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World J Surg. 2017 Apr;41(4):899-913. doi: 10.1007/s00268-016-3807-4.

Enhanced Recovery After Surgery Programs Improve Patient Outcomes and Recovery: A Meta-analysis.

Author information

1
Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Rd., Livingston, NJ, 07039, USA.
2
Saint George's University School of Medicine, St. George's, Grenada.
3
Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Rd., Livingston, NJ, 07039, USA. ronald.chamberlain@bannerhealth.com.
4
Saint George's University School of Medicine, St. George's, Grenada. ronald.chamberlain@bannerhealth.com.
5
Banner MD Anderson Cancer Center, 2940 E. Banner Gateway Dr., Gilbert, AZ, 85234, USA. ronald.chamberlain@bannerhealth.com.
6
Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA. ronald.chamberlain@bannerhealth.com.

Abstract

INTRODUCTION:

Enhanced recovery after surgery (ERAS) programs have been developed to improve patient outcomes, accelerate recovery after surgery, and reduce healthcare costs. ERAS programs are a multimodal approach, with interventions during all stages of care. This meta-analysis examines the impact of ERAS programs on patient outcomes and recovery.

METHODS:

A comprehensive search of all published randomized control trials (RCTs) assessing the use of ERAS programs in surgical patients was conducted. Outcomes analyzed were length of stay (LOS), overall mortality, 30-day readmission rates, total costs, total complications, time to first flatus, and time to first bowel movement.

RESULTS:

Forty-two RCTs involving 5241 patients were analyzed. ERAS programs significantly reduced LOS, total complications, and total costs across all types of surgeries (p < 0.001). Return of gastrointestinal (GI) function was also significantly improved, as measured by earlier time to first flatus and time to first bowel movement, p < 0.001. There was no overall difference in mortality or 30-day readmission rates; however, 30-day readmission rates after upper GI surgeries nearly doubled with the use of ERAS programs (RR = 1.922; p = 0.019).

CONCLUSIONS:

ERAS programs are associated with a significant reduction in LOS, total complications, total costs, as well as earlier return of GI function. Overall mortality and readmission rates remained similar, but there was a significant increase in 30-day readmission rates after upper GI surgeries. ERAS programs are effective and a valuable part in improving patient outcomes and accelerating recovery after surgery.

PMID:
27822725
DOI:
10.1007/s00268-016-3807-4
[Indexed for MEDLINE]

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