Meta-analysis of Enhanced Recovery After Surgery (ERAS) Protocols in Emergency Abdominal Surgery

Objectives To evaluate enhanced recovery after surgery (ERAS) protocols in emergency abdominal surgery. Methods The electronic data sources were explored to capture all studies that evaluated the impact of ERAS protocols in patients who underwent emergency abdominal surgery. The quality of randomised and non-randomised studies was evaluated by the Cochrane tool and the Newcastle-Ottawa scale, respectively. Random or fixed effects modelling were utilised as indicated. Results Six comparative studies, enrolling 1334 patients, were eligible. ERAS protocols resulted in shorter post-operative time to first flatus (mean difference: -1.40, P < 0.00001), time to first defecation (mean difference: -1.21, P = 0.02), time to first oral liquid diet (mean difference: -2.30, P < 0.00001), time to first oral solid diet (mean difference: -2.40, P < 0.00001) and length of hospital stay (mean difference: -3.09, -2.80, P < 0.00001). ERAS protocols also resulted in lower risks of total complications (odds ratio: 0.50, P < 0.00001), major complications (odds ratio: 0.60, P = 0.0008), pulmonary complications (odds ratio: 0.38, P = 0.0003), paralytic ileus (odds ratio: 0.53, 0.88, P = 0.01) and surgical site infection (odds ratio: 0.39, P = 0.0001). Both ERAS and non-ERAS protocols resulted in similar risk of 30-day mortality (risk difference: -0.00, P = 0.94), need for re-admission (risk difference: -0.01, P = 0.50) and need for re-operation (odds ratio: 0.83, P = 0.50). Conclusions Although ERAS protocols are commonly used in elective settings, they are associated with favourable outcomes in emergency settings as indicated by reduced post-operative complications, accelerated recovery of bowel function and shorter post-operative hospital stay without increasing need for re-admission or re-operation. There should be an effort to incorporate ERAS protocols into emergency abdominal surgery settings.