Enhanced recovery after surgery vs traditional recovery pathway after minimally invasive hysterectomy for benign indications: A systematic review and meta-analysis.

Objective: We aim to perform a meta-analysis comparing enhanced recovery after surgery (ERAS) and traditional recovery pathway (TRP) after minimally invasive hysterectomy (MIH) for benign conditions.

Data sources: A systematic search was conducted in June 2024 without date restrictions in PubMed, Embase, and Cochrane Central databases.

Method of study selection: This study included studies that compared ERAS and TRP in patients undergoing MIH for benign indications. The primary outcome was the length of hospital stay (LOHS). Sensitivity analysis was performed with a leave-one-out analysis, a trial sequential analysis, and a meta-regression to explore high heterogeneity.

Tabulation, integration, and results: The initial search identified 1,462 results, of which 8 studies met the inclusion criteria, comprising 948 patients. 5 studies were randomized controlled trials (RCTs). ERAS was associated with a significant reduction in LOHS (SMD -1.89 days; 95% CI -2.77 to -1.00; p<0.001), supported by a subgroup analysis of RCTs (SMD -1.59 days; 95% CI -2.69 to -0.49; p=0.005). ERAS was also associated with significant decrease for the overall complication rate (RR 0.64; 95% CI 0.41 to 0.99; p=0.04), postoperative pain score (MD -1.02; 95% CI -1.76 to -0.29; p=0.007), postoperative nausea and vomiting (PONV) (RR 0.40; 95% CI 0.28 to 0.56; p<0.001), and time to passage of flatus (MD -10.37; 95% CI -17.95 to -2.79; p=0.007). There was no difference in re-admission rate or operation duration. Trial sequential analysis confirmed no type 1 error, and meta-regression attributed high heterogeneity to different types of procedures between studies.

Conclusion: In conclusion, ERAS protocols for patients undergoing MIH for benign conditions were associated with reduction in LOHS, PONV, and postoperative pain. These improvements are achieved probably without an increase in complication or re-admission rates, highlighting the importance of broader adoption of ERAS for a better patient experience.