Enhanced Recovery Pathways Versus Standard Care After Cystectomy: A Meta-analysis of the Effect on Perioperative Outcomes

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• 作者：Mark D. Tyson^a ; ^b ; ^{tyson.mark@mayo.edu" class="auth_mail" title="E-mail the corresponding author} ; ^{scipubs@mayo.edu" class="auth_mail" title="E-mail the corresponding author} ; Sam S. Chang^b
• 关键词：Clinical pathways ; Collaborative care ; Cystectomy ; Enhanced recovery ; Fast track
• 刊名：European Urology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：70
• 期：6
• 页码：995-1003
• 全文大小：2485 K

文摘

Enhanced recovery after surgery (ERAS) protocols aim to improve surgical outcomes by reducing variation in perioperative best practices. However, among published studies, results show a striking variation in the effect of ERAS pathways on perioperative outcomes after cystectomy.

Objective

To perform a systematic review of the literature and a meta-analysis comparing the effectiveness of ERAS versus standard care on perioperative outcomes after cystectomy.

Evidence acquisition

We performed a literature search of PubMed, EMBASE, Web of Science, Google Scholar, the Cochrane Library, and the health-related grey literature in February 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis and the Cochrane Handbook. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine. Thirteen studies (1493 total patients) met the inclusion criteria (ERAS: 801, standard care: 692). A pooled meta-analysis of all comparative studies was performed using inverse-weighted, fixed-effects models, and random-effects models. Publication bias was graphically assessed using contour-enhanced funnel plots and was formally tested using the Harbord modification of the Egger test.

Evidence synthesis

Pooled data showed a lower overall complication rate (risk ratio [RR]: 0.85, 95% confidence interval [CI]: 0.74–0.97, p = 0.017, I² = 35.6%), a shorter length of stay (standardized mean difference:−0.87, 95% CI: −1.31 to −0.42, p = 0.001, I² = 92.8%), and a faster return of bowel function (standardized mean difference: −1.02, 95% CI: −1.69 to −0.34, p = 0.003, I² = 92.2%) in the ERAS group. No difference was noted for the overall readmission rates (RR: 0.74, 95% CI: 0.39–1.41, p = 0.36, I² = 51.4%), although a stratified analysis showed a lower 30-d readmission rate in the ERAS group (RR: 0.39, 95% CI: 0.19–0.83, p = 0.015, I² = 0%).

Conclusions

ERAS protocols reduce the length of stay, time-to-bowel function, and rate of complications after cystectomy.

Patient summary

Enhanced recovery after surgery pathways for cystectomy reduce complications and the amount of time patients spend in the hospital.