Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis
Christoph Kuemmerli, Christoph Tschuor, Meidai Kasai, Adnan Alseidi, Gianpaolo Balzano, Stefan A.W. Bouwense, Marco Braga, Mariëlle M.E. Coolsen, Sara K. Daniel, Christos Dervenis, Massimo Falconi, Dae Wook Hwang, Daniel J. Kagedan, Song Cheol Kim, Harish Lavu, Tingbo Liang, Daniel P. Nussbaum, Stefano Partelli, Michael Passeri, Nicolò Pecorelli, Sastha Ahanatha Pillai, Venu G. Pillarisetty, Michael J. Pucci, Wei Su, Robert P. Sutcliffe, Bobby Tingstedt, Marion van der Kolk, Dionisios Vrochides, Alice C. Wei, Caroline Williamsson, Charles J. Yeo, Sabino Zani, Efstratios Zouros, Mohammad Abu Hilal
Abstract
BACKGROUND: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. METHODS: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. RESULTS: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate. CONCLUSION: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.