Enhanced recovery programme after colorectal surgery in high-income and low-middle income countries: a systematic review and meta-analysis
Naim Slim, Wai Huang Teng, Ealaff Shakweh, Helena-Colling Sylvester, Mina Awad, Rebecca Schembri, Shady Hermena, Manish Chowdhary, Ravi Oodit, Nader Francis- General Medicine
- Surgery
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 & Methods:
We 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 (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 post-operative complications.
Results:
337 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 (
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.