open access
Meta-analysis for the evaluation of perioperative enhanced recovery after gynaecological surgery
Affiliations- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, China
open access
Abstract
Objectives: To systematically evaluate the effectiveness and safety of enhanced recovery after surgery (ERAS) in gynaecological surgery and provide a scientific basis for its clinical promotion and application in the Chinese population.
Material and methods: Systematic retrieval from CNKI, Wanfang, VIP database and other Chinese literature databases. Studies on ERAS application with a randomised controlled trial in gynaecological surgery were included in the present report. Outcome indicators: hospitalisation time, postoperative ambulation time, postoperative feeding time, postoperative exhaust time, postoperative defecation time, operation time, postoperative blood loss, postoperative morbidity, patient satisfaction, hospitalisation expenses, etc. The meta-analysis was performed using the Revman 5.3 software.
Results: A total of 24 studies were included in the analysis. The results showed that, compared with the traditional
group, the ERAS group had a lower hospitalisation time (SMD = −1.67, 95% CI = −2.03 ~ −1.30, p < 0.0001), postoperative ambulation time (SMD = −4.16, 95% CI = −5.12 ~ −3.20, p < 0.0001), postoperative feeding time (SMD = −7.36, 95% CI = −9.67 ~ −5.05, p < 0.0001), postoperative exhaust time (SMD = −2.59, 95% CI = −3.15 ~ −2.03, p < 0.0001), postoperative defecation time (SMD = −2.23, 95% CI = −2.88 ~ −1.57, p < 0.0001), postoperative morbidity (OR = 0.22, 95% CI = 0.15 ~ 0.31, p < 0.0001) and hospitalisation expenses (SMD = −0.53, 95% CI = −0.78 ~ −0.28, p < 0.0001). The patient satisfaction was significantly improved (odds ratio = 8.11, 95% CI = 4.96 ~ 13.24, p < 0.0001), and there were no significant differences in intraoperative blood loss and operation time between the two groups.
Conclusions: The application of the ERAS protocol in gynaecological surgery significantly improves the effectiveness
and safety of the procedure. Thus, it can be promoted and applied in clinical practice in China.
Abstract
Objectives: To systematically evaluate the effectiveness and safety of enhanced recovery after surgery (ERAS) in gynaecological surgery and provide a scientific basis for its clinical promotion and application in the Chinese population.
Material and methods: Systematic retrieval from CNKI, Wanfang, VIP database and other Chinese literature databases. Studies on ERAS application with a randomised controlled trial in gynaecological surgery were included in the present report. Outcome indicators: hospitalisation time, postoperative ambulation time, postoperative feeding time, postoperative exhaust time, postoperative defecation time, operation time, postoperative blood loss, postoperative morbidity, patient satisfaction, hospitalisation expenses, etc. The meta-analysis was performed using the Revman 5.3 software.
Results: A total of 24 studies were included in the analysis. The results showed that, compared with the traditional
group, the ERAS group had a lower hospitalisation time (SMD = −1.67, 95% CI = −2.03 ~ −1.30, p < 0.0001), postoperative ambulation time (SMD = −4.16, 95% CI = −5.12 ~ −3.20, p < 0.0001), postoperative feeding time (SMD = −7.36, 95% CI = −9.67 ~ −5.05, p < 0.0001), postoperative exhaust time (SMD = −2.59, 95% CI = −3.15 ~ −2.03, p < 0.0001), postoperative defecation time (SMD = −2.23, 95% CI = −2.88 ~ −1.57, p < 0.0001), postoperative morbidity (OR = 0.22, 95% CI = 0.15 ~ 0.31, p < 0.0001) and hospitalisation expenses (SMD = −0.53, 95% CI = −0.78 ~ −0.28, p < 0.0001). The patient satisfaction was significantly improved (odds ratio = 8.11, 95% CI = 4.96 ~ 13.24, p < 0.0001), and there were no significant differences in intraoperative blood loss and operation time between the two groups.
Conclusions: The application of the ERAS protocol in gynaecological surgery significantly improves the effectiveness
and safety of the procedure. Thus, it can be promoted and applied in clinical practice in China.
Keywords
ERAS; gynaecological surgery; systematic review; meta-analysis; effect evaluation
About this articleTitle
Meta-analysis for the evaluation of perioperative enhanced recovery after gynaecological surgery
Journal
Issue
Article type
Research paper
Pages
896-903
Published online
2022-06-28
Page views
3704
Article views/downloads
372
DOI
Pubmed
Bibliographic record
Ginekol Pol 2022;93(11):896-903.
Keywords
ERAS
gynaecological surgery
systematic review
meta-analysis
effect evaluation
Authors
Xiaofang Wu
Lingling Liu
Fang Zhou
References (36)- Guo XQ, Lu W, Wan XP. The core concept and basic principles of ERAS in gynecological [J]. J Prac Obste Gynecol. 2021; 37(2): 81–83.
- Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997; 78(5): 606–617.
- Moher D, Liberati A, Tetzlaff J, et al. PRISMA Group, PRISMA Group, PRISMA Group, PRISMA Group, PRISMA Group, PRISMA Group, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med. 2009; 6(7): e1000097–e130.
- Higgins JPT, Altman DG, Gøtzsche PC, et al. Cochrane Bias Methods Group, Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928.
- Lian GM, Huang W, Xu HX, et al. Application of ERAS concept in gynecologic malignant tumor patients undergoing minimally invasive surgery. J Qilu Nurs. 2020; 26(24): 61–63.
- Zhao W, Wang XJ. Evaluation of ERAS Mode in Patients with Gynecological Malignant Tumor Surgery [J]. China Practical Medicine. 2019; 14(7): 164–165.
- Yue FX. Application of ERAS in perioperative period of gynecological laparoscopy in high altitude areas [J]. High Alt Med Biol. 2018; 28(3): 38–39.
- Cai B. Effect of ERAS in Laparoscopic Surgery for Patients with Benign Gynecological Tumors and Evaluation of Psychological Fluctuation [J]. psy. 2020; 15(9): 15–16.
- Xu J, Xu LL. Application analysis of multidisciplinary cooperation ERAS in perioperative period of patients undergoing gynecological surgery [J]. Chinese And Foreign Medical Research. 2020; 18(4): 76–78.
- Gong GF, Yang QM, Yu WL, et al. ERAS effect analysis in gynecological laparoscopic surgery [J]. Guangdong medicine journal. 2019; 40(S1): 256–258.
- Wang JM, Han WQ. The application analysis of perioperative ERAS in gynecological laparoscopic surgery [J]. World Latest Medicine Information. 2019; 19(27): 68–69.
- Xiao LH. Analysis of the clinical value of comprehensive nursing intervention based on the concept of ERAS in the prevention of deep venous thrombosis of lower extremities after gynecological pelvic surgery [J]. Nursing Prac Res. 2019; 16(5): 76–79.
- Fang LL, He LL. Practice effect of ERAS in gynecological laparoscopic surgery [J]. The Journal of Medical Theory and Practice. 2021; 34(4): 694–695.
- Zhou JJ, Wu LP, Li CY. The effect of ERAS nursing concept applied to the perioperative period of patients with gynecological malignant tumor undergoing minimally invasive surgery [J]. Heilongjiang Journal of Traditional Chinese Medicine. 2020; 49(5): 325–326.
- Lv JP, Lv HR, Pang AJ. The application effect of ERAS nursing in gynecological tumor minimally invasive surgery [J]. Laboratory Medicine and Clinic. 2021; 18(13): 1968–1971.
- Liu LL, Yang JZ, Liu W. The application value of ERAS concept in gynecological laparoscopic surgery patients [J]. China Modern Medicine. 2020; 27(30): 71–74.
- Chen DL, Fang ZY. The feasibility and safety of the concept of ERAS in gynecological laparoscopic surgery. Women's Health Research. 2020(6): 107–108.
- Yu YM. The application of the concept of ERAS in the recovery of gastrointestinal function after gynecological laparoscopic surgery. Modern practical medicine. 2020; 32(04): 544–546.
- Wang J, Liu W, Tan WH. Effect analysis of ERAS concept in perioperative application of gynecological surgery. Practical Journal of Gynecology and Obstetrics. 2018; 34(3): 220–222.
- Wang J, Zhang L, Mao WJ, et al. Feasibility and safety analysis of the application of ERAS in gynecological laparoscopic surgery. Chinese Journal of Obstetrics and Gynecology. 2018; 19(6): 485–488.
- Cheng CX, Guo L, Liu ZF. The application of ERAS in gynecological laparoscopic surgery. Laparosc Surg. 2017; 9(9): 700–704.
- Chu BL, Chen Y, Yao HQ, et al. The application of ERAS in laparoscopic gynecological surgery. Modern Chinese Doctor. 2020; 58(11): 69–72.
- Huang ZJ, Qin HO. Effect of ERAS on postoperative rehabilitation of gynecological patients. Guangxi Medical Journal. 2012; 34(2): 242–243.
- Fan YH. Effect analysis of the concept of ERAS in gynecological malignant tumor surgery. World Latest Medicine Information. 2019; 19(99): 378–380.
- Zhang Q. Application of ERAS in perioperative period of gynecological laparoscopic surgery. Contemporary nurses (later issue). 2019; 27(3): 79–81.
- Lin ZB, Chen ZC, Wang SQ, et al. Application of ERAS in gynecological perioperative period. Chinese Journal of Healthy Birth & Child Care. 2014; 20(5): 303–305.
- Li GL, Yang DY, Gao LF, et al. The study of ERAS in perioperative period of gynecological tumor surgery patients. Hebei Medical Journal. 2017; 39(24): 3818–3820.
- Qiu HJ, Ji YQ, Liang DX, et al. To explore the effect of ERAS on the rehabilitation process of patients after gynecological surgery. Journal Of Practical Gynecologic Endocrinology. 2019; 6(6): 146–147.
- Wang JH, Kong XC, Zhang ZW. Systematic evaluation of the concept of ERAS applied to gynecological surgery. Journal of Practical Obstetrics and Gynecology. 2021; 37(2): 109–114.
- de Groot JJA, Ament SMC, Maessen JMC, et al. Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2016; 95(4): 382–395.
- Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations - Part I. Gynecol Oncol. 2016; 140(2): 313–322.
- Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations — Part II. Gynecol Oncol. 2016; 140(2): 323–332.
- Lewis SJ, Egger M, Sylvester PA, et al. Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ. 2001; 323(7316): 773–776.
- Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: enhanced recovery after surgery (ERAS) society recommendations-2019 update. Int J Gynecol Cancer. 2019; 29(4): 651–668.
- Relph S, Bell A, Sivashanmugarajan V, et al. Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post-implementation expenditures. Int J Health Plann Manage. 2014; 29(4): 399–406.
- Pache B, Joliat GR, Hübner M, et al. Cost-analysis of enhanced recovery after surgery (ERAS) program in gynecologic surgery. Gynecol Oncol. 2019; 154(2): 388–393.
