Enhanced recovery programme after colorectal surgery in high-income and low-middle income countries: a systematic review and meta-analysis.
Int J Surg
; 109(11): 3609-3616, 2023 Nov 01.
Article
en En
| MEDLINE
| ID: mdl-37598350
ABSTRACT
BACKGROUND:
Enhanced recovery after surgery (ERAS) protocols strive to optimise outcomes following elective surgery; however, there is a dearth of evidence to support its equitable application and efficacy internationally. MATERIALS ANDMETHODS:
The authors performed a systematic review and meta-analysis of studies on the uptake and impact of ERAS with the aim of highlighting differences in implementation and outcomes across high-income countries (HICs) and low-middle income countries (LMICs). The primary outcome was characterisation of global ERAS uptake. Secondary outcomes included length of hospital stay (LOS), 30-day readmission, 30-day mortality and postoperative complications.RESULTS:
Three hundred thirty-seven studies with considerable heterogeneity were included in the analysis (291 from HICs, and 46 from LMICs) with a total of 110 190 patients. The weighted median number of implemented elements were similar between HICs and LMICs ( P =0·94), but there was a trend towards greater uptake of less affordable elements across all aspects of the ERAS pathway in HICs. The mean LOS was significantly shorter in patient cohorts in HICs (5·85 days versus 7·17 days in LMICs, P <0·001). The 30-day readmission rate was higher in HICs (8·5 vs. 4·25% in LMICs, P <0·001, but no overall world-wide effect when ERAS compared to controls (OR 1·00, 95% CI 0·88-1·13). There were no reported differences in complications ( P =0·229) or 30-day mortality ( P =0·949).CONCLUSION:
Considerable variation in the structure, the implementation and outcomes of ERAS exists between HICs and LMICs, where affordable elements are implemented, contributing towards longer LOS in LMICs. Global efforts are required to ensure equitable access, effective ERAS implementation and a higher standard of perioperative care world-wide.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Cirugía Colorrectal
/
Recuperación Mejorada Después de la Cirugía
Tipo de estudio:
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Int J Surg
Año:
2023
Tipo del documento:
Article