Application Of Enhanced Recovery After Surgery In Setting Of Liver Surgery:A Meta-analysis

Objective:To systematically review the safety and effectiveness of the use of enhanced recovery after surgery(ERAS)compared to conventional care in patients undergoing liver surgery.Methods:Such databases as The Cochrane Library(CENTRAL),MEDLINE,EMBASE,Pub Med,CNKI,VIP,and Wan Fang Data were electronically searched for randomized controlled trials(RCTs)on application of ERAS in perioperative period of liver surgery.The retrieval time was from inception to June 2015.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed methodological quality.Then,meta-analysis was performed using Review Manager 5.3 software.Results:Ten RCTs were finally selected with a total of 1200 patients composed of 585 cases in ERAS group and 615 cases(undergoing traditional perioperative management)in control group.The results of Meta-analysis showed that in ERAS group compared with control group,the incidence of postoperative complications(RR=0.57,95% CI: 0.45~0.72,P<0.05),Grade I complications and Grade II-V complications(RR=0.63,95% CI: 0.42~0.95,P<0.05)(RR=0.54,95% CI: 0.39~0.74,P<0.05),length of hospital stay(WMD=-2.42,95% CI:-3.06~-1.79,P<0.05),time to functional recovery(WMD=-2.23,95% CI:-3.37~-1.10,P<0.05),time to first flatus(SMD=-0.85,95% CI:-1.32 ~-0.37,P<0.05),hospitalization costs(SMD=-0.91,95% CI:-1.38 ~-0.44,P<0.05),and intraoperative blood loss(WMD=-24.12,95% CI:-41.72~-6.51,P<0.05)were all significantly decreased.There were no statistical differences between the two groups in respects of the incidence of readmissions and operative time(all P>0.05).Conclusion:Use of ERAS protocols in the setting of liver surgery is safe and effective,and it can also reduce the length of hospital stay and incidence of postoperative complications,and thereby accelerate postoperative recovery of the patients.