Enhanced Recovery After Surgery In Gynecologic Surgery: A Meta-analysis

Objective: To compare enhanced recovery after surgery(ERAS)with traditional surgical concept for gynecologic surgical procedures by evaluating the index of postoperative recovery,safety and economic benefits.Methods: PubMed,EMBASE,Web of Science,the Cochrane Library,CNKI,VIP,WanFang and CBM were systematically searched for randomized controlled trials and non-randomized controlled trials which compared ERAS group and conventional care group for gynecologic surgical procedures published from the inception to January 2020.The quality of the included literatures for randomized controlled trials and non-randomized controlled trials was evaluated by Cochrane risk bias tool and New-castle-Ottawa scale respectively.Subgroup analysis was performed by surgical methods(open and minimally invasive),Stata 12.0 software was selected for meta-analysis.Results: Totally,28 articles were included in this study for meta-analysis,including 22 English articles and 6 Chinese articles.Among them,there were 6 randomized controlled trials and 22 non-randomized controlled trials(8 case-control studies and 14 cohort studies).A total of 6705 patients were included,3304 cases in the ERAS groupand 3392 cases in the conventional care group.Meta-analysis showed that total length of hospital stay(WMD =-0.69,95% CI =-0.97 ~-0.41,P = 0.000),postoperative length of hospital stay(WMD =-0.63,95% CI =-0.84 ~-0.42,P = 0.000),time to bowel function return(WMD =-0.36,95% CI =-0.57 ~-0.16,P = 0.001),intro-operative blood loss(WMD =-26.57,95% CI =-47.39 ~-5.74,P = 0.012)and hospital charge(WMD =-817.61,95% CI =-1263.35 ~-317.87,P = 0.000)were significantly decreased for ERAS group when compared to conventional care group.There were no statistically significant differences in operative time,the incidence of 30-day postoperative complications,30-day hospital readmission rates and 30-day mortality rates between two groups.Conclusion: Compared to conventional care group,ERAS group can short the total length of hospital stay,postoperative length of hospital stay,time to bowel function return and decrease hospital charge at the same time without any increase in 30-days complications after discharge,30-days hospital readmission rates and 30-days mortality rates,suggesting that the application of ERAS in gynecologic surgical procedures is safe and effective and can produce positive economic benefits.