Enhanced Recovery Pathways versus Standard Care after Cystectomy: A Meta-analysis and Systemtic Review

• Main Authors: Hong CHENG, Shuhui SI, Yu-xiao ZHENG, Jian-zhong ZHANG, Feng QI, Dong-liang CAO, Chuan-jie ZHANG, Gui-ya JIANG, Si SUN, Xin-wei WANG
• Format: Article
• Language: English
• Published: Third Party Medicine International Publishing Group Co. Limited 2018-04-01
• Series: Journal of International Translational Medicine
• Subjects: ERAS; Radical cystectomy; Collaborative care; Fast track; Clinical pathways
• Online Access: http://dx.doi.org/10.11910/2227-6394.2018.06.01.05

Objective: To compare the outcomes of enhanced recovery after surgery (ERAS) and standard Care (SC) after radical cystectomy. Methods: PubMed, Embase, Web ofScience, Medline and the Cochrane Library were searched to identify relevant studies, and the last update was up to till October 2017 according to the preferred reporting items for systematic review and meta-analysis (PRISMA). Twenty studies were suitable for inclusion criteria. Risk ratios (RRs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were used to assess the effects of ERAS or SC calculated. Relevant outcomes were compared. We used contour-enhanced funnel plots and Harbord modificationof the Egger test to assess the publication bias. Results: We observed a lower overall complication rate (RR:0.86, 95% CI: 0.79-0.93, P = 0.502, I 2 = 0%), a shorter LOS (SMD: -1.02, 95% CI: -1.52 to -0.53, P = 0.000, I 2 =96.7%), and a faster recovery of bowel function (SMD: -1.13, 95% CI: -1.73 to-0.53, P = 0.000, I 2 = 95.1%) in the ERAS group after cystectomy. There was no differencesin the 90-d readmission rates (RR: 1.00, 95% CI: 0.82-1.21, P = 0.238, I 2 = 26.2%) and 30-dreadmission rate inthe ERAS group (RR: 0.78, 95% CI: 0.52-1.16, P = 0.075, I 2= 45.7%). Moreover, no significant differences were found regardingEBL (SMD:-0.11, 95% CI: -0.39-0.17, P = 0.462, I 2 = 0%), number of lymph nodes removed rate (SMD: 0.06, 95% CI: -0.18-0.30, P = 0.232, I 2 = 31.5%) and transfusion rate (RR: 0.89, 95% CI: 0.74-1.07, P = 0.958, I 2 = 0%). Conclusions: ERAS protocols might reduce LOS, time-to-bowel function, and rateof overall complications after cystectomy.