Enhanced Recovery Pathways versus Standard Care after Cystectomy: A Meta-analysis and Systemtic Review

Hong CHENG, Shuhui SI, Yu-xiao ZHENG, Jian-zhong ZHANG, Feng QI, Dong-liang CAO, Chuan-jie ZHANG, Gui-ya JIANG, Si SUN, Xin-wei WANG
2018 Journal of International Translational Medicine  
Objective: To compare the outcomes of enhanced recovery after surgery (ERAS) and standard Care (SC) after radical cystectomy. Methods: PubMed, Embase, Web ofScience, Medline and the Cochrane Library were searched to identify relevant studies, and the last update was up to till October 2017 according to the preferred reporting items for systematic review and meta-analysis (PRISMA). Twenty studies were suitable for inclusion criteria. Risk ratios (RRs) or standardized mean differences (SMDs) with
more » ... erences (SMDs) with corresponding 95% confidence intervals (CIs) were used to assess the effects of ERAS or SC calculated. Relevant outcomes were compared. We used contour-enhanced funnel plots and Harbord modificationof the Egger test to assess the publication bias. Results: We observed a lower overall complication rate (RR:0.86, 95% CI: 0.79-0.93, P = 0.502, I 2 = 0%), a shorter LOS (SMD: -1.02, 95% CI: -1.52 to -0.53, P = 0.000, I 2 =96.7%), and a faster recovery of bowel function (SMD: -1.13, 95% CI: -1.73 to-0.53, P = 0.000, I 2 = 95.1%) in the ERAS group after cystectomy. There was no differencesin the 90-d readmission rates (RR: 1.00, 95% CI: 0.82-1.21, P = 0.238, I 2 = 26.2%) and 30-dreadmission rate inthe ERAS group (RR: 0.78, 95% CI: 0.52-1.16, P = 0.075, I 2= 45.7%). Moreover, no significant differences were found regardingEBL (SMD:-0.11, 95% CI: -0.39-0.17, P = 0.462, I 2 = 0%), number of lymph nodes removed rate (SMD: 0.06, 95% CI: -0.18-0.30, P = 0.232, I 2 = 31.5%) and transfusion rate (RR: 0.89, 95% CI: 0.74-1.07, P = 0.958, I 2 = 0%). Conclusions: ERAS protocols might reduce LOS, time-to-bowel function, and rateof overall complications after cystectomy.
doi:10.11910/2227-6394.2018.06.01.05 doaj:2b339fa8e8e1412982a8a29b88c27288 fatcat:b5ruq6pxtzfyhfxkpkh5mlvuma