PDF(Pubmed)
Abstract：
UNASSIGNED: A comprehensive review of the evidence exploring the outcomes of enhanced recovery after surgery (ERAS) guidelines has not been completed.
UNASSIGNED: To evaluate if ERAS guidelines are associated with improved hospital length of stay, hospital readmission, complications, and mortality compared with usual surgical care, and to understand differences in estimates based on study and patient factors.
UNASSIGNED: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central were searched from inception until June 2021.
UNASSIGNED: Titles, abstracts, and full-text articles were screened by 2 independent reviewers. Eligible studies were randomized clinical trials that examined ERAS-guided surgery compared with a control group and reported on at least 1 of the outcomes.
UNASSIGNED: Data were abstracted in duplicate using a standardized data abstraction form. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Risk of bias was assessed in duplicate using the Cochrane Risk of Bias tool. Random-effects meta-analysis was used to pool estimates for each outcome, and meta-regression identified sources of heterogeneity within each outcome.
UNASSIGNED: The primary outcomes were hospital length of stay, hospital readmission within 30 days of index discharge, 30-day postoperative complications, and 30-day postoperative mortality.
UNASSIGNED: Of the 12 047 references identified, 1493 full texts were screened for eligibility, 495 were included in the systematic review, and 74 RCTs with 9076 participants were included in the meta-analysis. Included studies presented data from 21 countries and 9 ERAS-guided surgical procedures with 15 (20.3%) having a low risk of bias. The mean (SD) Reporting on ERAS Compliance, Outcomes, and Elements Research checklist score was 13.5 (2.3). Hospital length of stay decreased by 1.88 days (95% CI, 0.95-2.81 days; I2 = 86.5%; P < .001) and the risk of complications decreased (risk ratio, 0.71; 95% CI, 0.59-0.87; I2 = 78.6%; P < .001) in the ERAS group. Risk of readmission and mortality were not significant.
UNASSIGNED: In this meta-analysis, ERAS guidelines were associated with decreased hospital length of stay and complications. Future studies should aim to improve implementation of ERAS and increase the reach of the guidelines.
UNASSIGNED: To evaluate if ERAS guidelines are associated with improved hospital length of stay, hospital readmission, complications, and mortality compared with usual surgical care, and to understand differences in estimates based on study and patient factors.
UNASSIGNED: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central were searched from inception until June 2021.
UNASSIGNED: Titles, abstracts, and full-text articles were screened by 2 independent reviewers. Eligible studies were randomized clinical trials that examined ERAS-guided surgery compared with a control group and reported on at least 1 of the outcomes.
UNASSIGNED: Data were abstracted in duplicate using a standardized data abstraction form. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Risk of bias was assessed in duplicate using the Cochrane Risk of Bias tool. Random-effects meta-analysis was used to pool estimates for each outcome, and meta-regression identified sources of heterogeneity within each outcome.
UNASSIGNED: The primary outcomes were hospital length of stay, hospital readmission within 30 days of index discharge, 30-day postoperative complications, and 30-day postoperative mortality.
UNASSIGNED: Of the 12 047 references identified, 1493 full texts were screened for eligibility, 495 were included in the systematic review, and 74 RCTs with 9076 participants were included in the meta-analysis. Included studies presented data from 21 countries and 9 ERAS-guided surgical procedures with 15 (20.3%) having a low risk of bias. The mean (SD) Reporting on ERAS Compliance, Outcomes, and Elements Research checklist score was 13.5 (2.3). Hospital length of stay decreased by 1.88 days (95% CI, 0.95-2.81 days; I2 = 86.5%; P < .001) and the risk of complications decreased (risk ratio, 0.71; 95% CI, 0.59-0.87; I2 = 78.6%; P < .001) in the ERAS group. Risk of readmission and mortality were not significant.
UNASSIGNED: In this meta-analysis, ERAS guidelines were associated with decreased hospital length of stay and complications. Future studies should aim to improve implementation of ERAS and increase the reach of the guidelines.
摘要：
■尚未完成对探索增强术后恢复（ERAS）指南结果的证据的全面审查。
■为了评估ERAS指南是否与改善住院时间相关，医院再入院,并发症,和死亡率与常规手术治疗相比，并了解基于研究和患者因素的估计差异。
■MEDLINE,Embase,护理和相关健康文献的累积指数，和CochraneCentral从一开始就被搜索到2021年6月。
■标题，摘要,全文由两名独立审稿人筛选。符合条件的研究是随机临床试验，与对照组相比，检查了ERAS引导的手术，并报告了至少1个结果。
■使用标准化数据抽象表单对数据进行一式两份的抽象。该研究遵循了系统评价和荟萃分析的首选报告项目。使用Cochrane偏差风险工具重复评估偏差风险。随机效应荟萃分析用于汇集每个结果的估计值，元回归确定了每个结果中异质性的来源。
■主要结果是住院时间，出院后30天内再次入院，术后30天并发症,和术后30天死亡率。
■在确定的12047个参考文献中，1493个全文进行了资格筛选，495人被纳入系统评价，和74个RCTs,9076名参与者被纳入荟萃分析.纳入的研究提供了来自21个国家和9个ERAS引导的外科手术的数据，其中15个（20.3％）具有低偏倚风险。ERAS合规性的平均值(SD)报告，结果，要素研究清单得分为13.5(2.3)。住院时间减少1.88天(95%CI,0.95-2.81天;I2=86.5%;P<.001),并发症风险降低(风险比,ERAS组0.71；95%CI，0.59-0.87；I2=78.6%；P<.001）。再入院和死亡率的风险并不显著。
■在此荟萃分析中，ERAS指南与住院时间减少和并发症相关。未来的研究应旨在改善ERAS的实施并增加指南的覆盖范围。
■为了评估ERAS指南是否与改善住院时间相关，医院再入院,并发症,和死亡率与常规手术治疗相比，并了解基于研究和患者因素的估计差异。
■MEDLINE,Embase,护理和相关健康文献的累积指数，和CochraneCentral从一开始就被搜索到2021年6月。
■标题，摘要,全文由两名独立审稿人筛选。符合条件的研究是随机临床试验，与对照组相比，检查了ERAS引导的手术，并报告了至少1个结果。
■使用标准化数据抽象表单对数据进行一式两份的抽象。该研究遵循了系统评价和荟萃分析的首选报告项目。使用Cochrane偏差风险工具重复评估偏差风险。随机效应荟萃分析用于汇集每个结果的估计值，元回归确定了每个结果中异质性的来源。
■主要结果是住院时间，出院后30天内再次入院，术后30天并发症,和术后30天死亡率。
■在确定的12047个参考文献中，1493个全文进行了资格筛选，495人被纳入系统评价，和74个RCTs,9076名参与者被纳入荟萃分析.纳入的研究提供了来自21个国家和9个ERAS引导的外科手术的数据，其中15个（20.3％）具有低偏倚风险。ERAS合规性的平均值(SD)报告，结果，要素研究清单得分为13.5(2.3)。住院时间减少1.88天(95%CI,0.95-2.81天;I2=86.5%;P<.001),并发症风险降低(风险比,ERAS组0.71；95%CI，0.59-0.87；I2=78.6%；P<.001）。再入院和死亡率的风险并不显著。
■在此荟萃分析中，ERAS指南与住院时间减少和并发症相关。未来的研究应旨在改善ERAS的实施并增加指南的覆盖范围。
