Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: A meta-analysis

Objective: Enhanced recovery after surgery (ERAS) programs are a series of measures being taken during the perioperation to alleviate surgical stress and accelerate the recovery rate of patients. Although several studies reported the efficacy of ERAS in liver surgery, the role of ERAS in laparoscopic hepatectomy is still unclear. This meta-analysis is aimed to evaluate the efficacy and safety of ERAS programs versus traditional care in laparoscopic hepatectomy. Methods: We searched PubMed, EMBASE, the Cochrane Library, CNKI, Wang Fang Database and VIP Database for randomized controlled trials (RCTs) or clinical controlled trials (CCTs) concerning using ERAS in laparoscopic hepatectomy. Data collection ended in June 1st, 2016. The main end points were intraoperative blood loss, intraoperative blood transfusion, operative time, the cost of hospitalization, time to first flatus, the time to first diet after surgery, duration of postoperative hospital stay, total postoperative complication rate, grade. complication rate, grade II-V complication rate. Results: 8 studies with 580 patients were eligible for analysis. There were 292 cases in ERAS group and 288 cases in traditional perioperative care (CTL) group. Compared with CTL group, ERAS group was associated with significantly accelerated of time to first diet after surgery (SMD = - 1.79, 95% CI: -3.19 similar to -0.38, P = 0.01), time to first flatus (MD = -0.51, 95% CI: - 0.91 similar to - 0.12, P = 0.01). Meanwhile, it was associated with significantly decreased of duration of the postoperative hospital stay (MD = -.31, 95% CI: -3.95 similar to -2.67, P < 0.00001), cost of hospitalization (MD = -1.0, 95% CI: -1.49 similar to -0.51, P < 0.0001), total postoperative complication rate (OR = 0.34, 95% CI: 0.15-0.75, P = 0.008), grade. complication rate (OR = 0.37, 95% CI: 0.22-0.64, P = 0.0003) and gradeII-Vcomplication rate (OR = 0.49, 95% CI: 0.32-0.77, P = 0.002). Whereas there was no significantly difference in intraoperative blood loss (P > 0.05), intraoperative blood transfusion (P > 0.05), operative time (P > 0.05) between ERAS group and CTL group. Conclusion: Application of ERAS in laparoscopic hepatectomy is safe and effective, and it could accelerate the postoperative recovery and lighten the financial burden of patients. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.