Enhancing recovery after minimally invasive surgery in children: A systematic review of the literature and meta-analysis

被引:25
作者
Dagorno, Claire [1 ]
Montalva, Louise [1 ]
Ali, Liza [1 ]
Brustia, Raffaele [2 ,3 ]
Paye-Jaquen, Annabel [1 ,2 ]
Pio, Luca [1 ,2 ]
Bonnard, Arnaud [1 ,2 ,4 ]
机构
[1] Robert Debre Univ Hosp, AP HP, Dept Pediat Surg & Urol, 48 Blvd Serurier, F-75019 Paris, France
[2] Paris Univ, Paris, France
[3] Henri Mondor Univ Hosp, Dept Colorectal & Hepatobiliary Surg, Creteil, France
[4] Univ Paris Diderot Sorbonne Paris Cite, UFR Med, Paris, France
关键词
ERAS; Laparoscopy; Thoracoscopy; Retroperitoneoscopy; Fast-track; Minimally invasive surgery; STAY;
D O I
10.1016/j.jpedsurg.2021.04.004
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective: Enhanced recovery after surgery (ERAS) has been widely implemented after minimally invasive surgeries (MIS) in adults. The aim of this study was to evaluate the current evidence available on ERAS after MIS in children. Methods: Using a defined search strategy (PubMed, Cochrane, Scopus), we performed a systematic review of the literature, searching for studies reporting on ERAS after MIS (thoracoscopy, laparoscopy, retroperitoneoscopy) in children (1975-2019). This study was registered with PROSPERO-international prospective register of systematic reviews. A meta-analysis was conducted using comparative studies for length of stay (LOS), complication rates, and readmission rates. Results: Of 180 abstracts screened, 20 full-text articles were analyzed, and 9 were included in our systematic review (1 randomized controlled trial, 3 prospective, and 5 retrospective studies), involving a total number of 531 patients. ERAS has been applied to laparoscopy for digestive (n = 7 studies) or urologic surgeries (n = 1), as well as thoracoscopy (n = 1). Mean LOS was decreased in ERAS children compared to controls (6 studies, -1.12 days, 95%IC: -1.5 to -0.82, p < 0.00001). There was no difference in complication rates between ERAS children and control children (5 studies, 13% vs 14%, OR = 0.84, 95%CI: 0.49-1.44, p = 0.52). The 30-day readmission rate was decreased in ERAS children compared to controls (6 studies, 4% vs 10%, OR = 0.34, 95%CI: 0.18-0.66, p = 0.001). Conclusions: Although the evidence regarding ERAS in MIS is scarce, these protocols seem safe and effective, by decreasing LOS and 30-day readmission rate, without increasing post-operative complication rates. (c) 2021 Elsevier Inc. All rights reserved.
引用
收藏
页码:2157 / 2164
页数:8
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