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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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.</p><p><strong>Main outcome measures: </strong>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.</p><p><strong>Results: </strong>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; <i>P</i>=0.02] without increasing readmission rates (RR: 1.13; 95% CI: 0.75-1.73; <i>P</i>=0.55). No significant differences were observed in Clavien-Dindo grade I-II complications (RR: 0.75; 95% CI: 0.49-1.16; <i>P</i>=0.20) or grade III or higher complications rates (RR: 0.60; 95% CI: 0.27-1.33; <i>P</i>=0.21).</p><p><strong>Conclusions: </strong>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.</p><p><strong>What is new?: </strong>The application of ERAS protocols is associated with better postoperative outcomes in patients undergoing major surgeries for DIE.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"17 1","pages":"15-29"},"PeriodicalIF":1.7000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042144/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of Enhanced Recovery After Surgery (ERAS) guidelines implementation in deep infiltrating endometriosis surgery. 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引用次数: 0
摘要
背景：深浸润性子宫内膜异位症（DIE）手术治疗的复杂性要求优化围手术期护理方案，以确保最佳的术后效果。目的：本荟萃分析评估了与传统围手术期护理相比，手术后增强恢复（ERAS）方案在DIE手术患者中的有效性。方法：系统检索Medline、Scopus、谷歌Scholar、Cochrane CENTRAL和ClinicalTrials.gov数据库自成立至2024年8月的文献。采用RevMan 5.4软件（Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020）进行meta分析，采用平均差异（md）、合并风险比（RR）和随机效应模型。使用非随机干预研究的偏倚风险和偏倚风险工具进行质量评估。主要结局指标：评估的主要结局是术后住院时间和再入院率。次要结局包括Clavien-Dindo I-II级和III级或更高的并发症发生率。结果：纳入4项比较研究，共纳入1662例患者。ERAS方案显著缩短了平均住院时间[MD: -2.88天；95%置信区间（CI）： -5.34 ~ -0.41；P=0.02]未增加再入院率(RR: 1.13；95% ci: 0.75-1.73；P = 0.55)。Clavien-Dindo I-II级并发症无显著性差异(RR: 0.75；95% ci: 0.49-1.16；P=0.20)或III级及以上并发症发生率(RR: 0.60；95% ci: 0.27-1.33；P = 0.21)。结论：ERAS方案似乎减少了死亡手术的住院时间，而没有增加并发症或再入院率。然而，仍需要进行进一步的大规模随机研究来证实这些发现。有什么新鲜事吗？ERAS方案的应用与接受DIE大手术的患者术后预后较好相关。
Impact of Enhanced Recovery After Surgery (ERAS) guidelines implementation in deep infiltrating endometriosis surgery. A systematic review and meta-analysis.
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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