Impact of Enhanced Recovery After Surgery (ERAS) guidelines implementation in deep infiltrating endometriosis surgery. A systematic review and meta-analysis.
Athanasios Douligeris, Nikolaos Kathopoulis, Christina Karasmani, Konstantinos Kypriotis, Dimitrios Zacharakis, Anastasia Mortaki, Anastasia Prodromidou, Ioannis K Chatzipapas, Themos Grigoriadis, Athanasios Protopapas
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Abstract
Background: The complexity of surgical management in women with deep infiltrating endometriosis (DIE) demands the optimisation of perioperative care protocols to ensure optimal postoperative outcomes.
Objectives: This meta-analysis evaluates the effectiveness of Enhanced Recovery After Surgery (ERAS) protocols compared to conventional perioperative care in patients undergoing surgery for DIE.
Methods: A systematic literature search was conducted in Medline, Scopus, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov databases from inception till August 2024. Meta-analysis was performed with RevMan 5.4 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020), with mean differences (MDs), pooled risk ratios (RR) and random-effects model. Quality assessment was performed using the Risk of Bias in Non-randomised Studies of Interventions and Risk of Bias tools.
Main outcome measures: Primary outcomes assessed were postoperative length of hospital stay and readmission rates. Secondary outcomes included Clavien-Dindo grade I-II and grade III or higher complication rates.
Results: Four comparative studies were included, encompassing a total of 1,662 patients. ERAS protocols significantly reduced the mean length of hospital stay [MD: -2.88 days; 95% confidence interval (CI): -5.34 to -0.41; P=0.02] without increasing readmission rates (RR: 1.13; 95% CI: 0.75-1.73; P=0.55). No significant differences were observed in Clavien-Dindo grade I-II complications (RR: 0.75; 95% CI: 0.49-1.16; P=0.20) or grade III or higher complications rates (RR: 0.60; 95% CI: 0.27-1.33; P=0.21).
Conclusions: ERAS protocols appear to reduce the length of hospital stay without increasing complications or readmissions in DIE surgery. However, further large-scale randomised studies still needed to be conducted to confirm these findings.
What is new?: The application of ERAS protocols is associated with better postoperative outcomes in patients undergoing major surgeries for DIE.
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