Application of enhanced recovery after surgery in perioperative period of hepatectomy: a Meta-analysis

Objective To systematically review the value of enhanced recovery after surgery ( ERAS) in the perioperative period of hepatectomy. Methods A literature search was conducted in Pub Med, Embase, Cochrane Library, Sinomed, Wanfang Data, VIP, and CNKI to identify the articles on the application of ERAS in the perioperative period of hepatectomy published up to July 2017. Quality evaluation and data extraction were performed for the included articles. A Meta-analysis was performed using Revman 5. 3 software. Results A total of 17 articles were included, with 14 randomized controlled trials and 3 controlled clinical trials. A total of 2220 patients were involved and divided into ERAS group ( n = 1002) and control group ( n = 1218) . Compared with the control group, the ERAS group had significantly shortened length of postoperative hospital stay ( weighted mean difference [WMD]=-2. 58, 95% confidence interval [CI]:-3. 47 to-1. 70, P<0. 05) , functional rehabilitation time ( WMD =-3. 39, 95% CI:-4. 32 to-2. 45, P < 0. 05) , and time to first flatus ( standardized mean difference [SMD]=-1. 56, 95% CI:-2. 15 to-0. 97, P < 0. 05) , as well as reduced complication rate ( odds ratio [OR]= 0. 64, 95%CI: 0. 52-0. 78, P < 0. 05) and hospital costs ( SMD =-0. 85, 95% CI:-1. 23 to-0. 47, P < 0. 05) . There were no significant differences between the two groups in readmission rate ( OR = 1. 28, 95% CI: 0. 69-2. 69, P >0. 05) , operation time ( WMD =-11. 36, 95% CI:-23. 25 to 0. 53, P > 0. 05) , and intraoperative blood loss ( WMD =-22. 62, 95% CI:-38. 89 to-6. 34, P > 0. 05) . Conclusion ERAS is safe and effective in the perioperative period of hepatectomy and holds promise for clinical application.