Application of enhanced recovery after surgery versus traditional rehabilitation program in hepatectomy: a Meta-analysis

• Main Author: LI Le
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2018-02-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=8758

ObjectiveTo investigate the effect of enhanced recovery after surgery (ERAS) versus traditional rehabilitation program in patients undergoing hepatectomy. MethodsPubMed, EBSCO, MEDLINE, and Cochrane Library were searched for the articles on the effect of ERAS versus traditional rehabilitation program in liver surgery published up to August 2016. Two independent observers performed quality assessment and data extraction according to the inclusion and exclusion criteria, and RevMan 5.3.5 was used for the Meta-analysis. ResultsA total of 4 articles with 524 patients (254 patients in ERAS group and 270 in traditional treatment group) were included. Compared with the traditional treatment group, the ERAS group had significantly shorter length of postoperative hospital stay (weighted mean difference ［WMD］=-2.72, 95% confidence interval ［CI］: -3.86 to -1.57, P＜0.000 01), shorter time to functional recovery (WMD=-2.67, 95% CI: -3.68 to -1.65, P＜0.000 01), and lower overall incidence rate of complications (odds ratio ［OR］=0.45, 95% CI: 0.30-0.67, P＜0.000 1). The subgroup analysis showed that the ERAS group also had significantly lower incidence rates of grade 1 and grade 2-5 complications than the traditional treatment group (grade 1: OR=0.55, 95% CI: 0.31-0.98, P＜0.05; grade 2-5: OR=0.49, 95% CI: 0.32-0.76, P＜0.05). There was no significant difference in rehospitalization rate between the two groups (P＞0.05). As for the level of C-reactive protein, there was no significant difference between the two groups at 1 and 3 days after surgery (P＞0.05), but the ERAS group had a significantly lower level than the traditional treatment group at 5 days after surgery (WMD=-21.68, 95% CI: -29.30 to -14.05, P＜0.000 1). The ERAS group also had a significantly shorter time to first flatus than the traditional treatment group (WMD=-0.93, 95% CI: -1.41 to -0.46, P=0.000 1). ConclusionERAS is safe, effective, and feasible in liver surgery.