• Br J Surg · Feb 2022

    Meta Analysis

    Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis.

    • Christoph Kuemmerli, Christoph Tschuor, Meidai Kasai, Adnan A Alseidi, Gianpaolo Balzano, Stefan Bouwense, Marco Braga, Mariëlle Coolsen, Sara K Daniel, Christos Dervenis, Massimo Falconi, Dae Wook Hwang, Daniel J Kagedan, Song Cheol Kim, Harish Lavu, Tingbo Liang, Daniel Nussbaum, Stefano Partelli, Michael J Passeri, Nicolò Pecorelli, Sastha Ahanatha Pillai, Venu G Pillarisetty, Michael J Pucci, Wei Su, Robert P Sutcliffe, Bobby Tingstedt, Marion van der Kolk, Dionisios Vrochides, Alice Wei, Caroline Williamsson, Charles J Yeo, Sabino Zani, Efstratios Zouros, and Mohammed Abu Hilal.
    • Department of Surgery, Foundation Poliambulanza, Brescia, Italy.
    • Br J Surg. 2022 Feb 24; 109 (3): 256-266.

    BackgroundThis individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy.MethodsThe Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission.ResultsIndividual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate.ConclusionERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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