Enhanced Recovery After Surgery Versus Conventional Care in Elderly Patients Undergoing Transvaginal Pelvic Floor Reconstruction: A Systematic Review and Meta-Analysis.

Abstract

Introduction and hypothesis: Pelvic organ prolapse is a common condition in older women requiring surgical correction. The benefits of Enhanced Recovery After Surgery (ERAS) have been demonstrated in gynecological procedures, but there are still few data on its use in older patients (aged 60 years and above) undergoing transvaginal pelvic floor reconstruction. This study evaluates the effectiveness and safety of ERAS compared with conventional perioperative care, specifically in this older population.

Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Cochrane databases were searched for randomized and observational studies comparing ERAS with conventional care in older patients undergoing transvaginal pelvic floor reconstruction. Outcomes assessed were time to first intestinal exhaust, ambulation, urinary catheterization duration, hospital stay, operative time, bleeding volume, 30-day readmission, and reoperation rates. Data extraction and quality assessment were performed independently, and pooled analyses were conducted using a random-effects model.

Results: Nine studies involving 1,585 patients were included. ERAS significantly reduced time to first intestinal exhaust, ambulation, urinary catheter removal, and postoperative length of stay compared with conventional care. No significant differences were observed in operative duration, intraoperative bleeding, 30-day readmission, or reoperation rates.

Conclusions: For older patients undergoing transvaginal pelvic floor reconstruction, ERAS enhances postoperative recovery without sacrificing safety. The need for multicenter randomized studies and standardized protocols remains despite encouraging findings.