Effectiveness of Enhanced Recovery After Surgery protocol in pancreatic surgery: a systematic review and meta-analysis of randomized controlled trials

Background: The Enhanced Recovery After Surgery (ERAS) protocol represents an advancement in perioperative care to reduce surgical stress and accelerate recovery. This meta-analysis aimed to evaluate the effectiveness of ERAS in pancreatic surgery and to assess the effect of the ERAS protocol vs conventional hospital care on postoperative outcomes, including length of stay (LOS) in the hospital, hospital costs, readmission rates, and infection rates in patients undergoing pancreatic surgery. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant RCTs. Data were extracted and analyzed using a random effects model. Statistical analyses were performed using RStudio. Results: A total of 7 RCTs involving 731 patients were included. The meta-analysis showed a statistically significant reduction in LOS by 2.49 days (mean difference, -2.49; 95% CI, -4.20 to -0.79; P <.01) with considerable heterogeneity (I-2 = 86%). Hospital costs were significantly reduced (standardized mean difference, -0.36; 95% CI, -0.65 to -0.06; P =.02) with moderate heterogeneity (I-2 = 52%). The readmission and infection rates showed no statistically significant differences between the ERAS and control groups. The Egger test indicated no significant publication bias. Conclusion: The ERAS protocol significantly reduced LOS and hospital costs in patients who underwent pancreatic surgery. Our findings support the implementation of ERAS protocols to enhance recovery and optimize outcomes. To the best of our knowledge, our study is the first to demonstrate these results using an RCT-only meta-analysis approach in pancreatic surgery, highlighting the value of ERAS in improving perioperative care. (c) 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights are reserved, in-cluding those for text and data mining, AI training, and similar technologies.