ERATS decreased length of stay, postoperative complications, and readmission.
Figure 1. L'abbe plot for 30-day readmission. For each study, the 30-day readmission rate for the nonenhanced recovery after thoracic surgery (non-ERATS) group (horizontal axis) was plotted against the 30-day readmission rate for the ERATS group (vertical axis). The studies are plotted as points of varying sizes. The larger points indicate greater precision (1/standard error) in the treatment effect estimate between the 2 groups in the study, smaller points indicate less precision. In the meta-analysis, more precise estimates are given more weight. The gray 45° line indicates equal event rates between the 2 groups. The red line indicates the random-effects meta-analysis event rate. Points above the gray line indicate a higher observed event rate in the ERATS group compared with the non-ERATS group, points below the gray line indicate a higher observed event rate in the non-ERATS group, and points along the gray line indicate equal observed event rates between the ERATS and non-ERATS group. Similarly, points above the red line indicate higher observed event rates in the ERATS group than the estimated meta-analytic effect, points below the red line indicate higher observed event rates in the…
Figure 2. Forest plot for length of stay. For each study, a point along the horizontal axis denotes the mean difference between the enhanced recovery after thoracic surgery (ERATS) group and the non-ERATS group. The size of the point is proportional to the precision of the estimate with more precise estimates, estimates with smaller standard errors, having larger points and less precise estimates represented with smaller points. The 95% confidence intervals for the mean difference are also plotted. Points to the left of the gray vertical line at x = 0 indicate that the ERATS group had shorter mean lengths of stays than that of the non-ERATS group; points to the left of the gray vertical line indicate that the ERATS group had longer mean lengths of stays than the non-ERATS group; and points on the gray line indicate no difference in the mean lengths of stays between the 2 groups. The dotted red line indicates the grand mean from the random-effects meta-analysis.
Figure 3. In this systematic review and meta-analysis of enhanced recovery after thoracic surgery (ERATS), we analyzed 19 studies comparing pre-ERATS and post-ERATS outcomes (N = 8447 patients overall) per the preferred reporting items for systematic reviews and meta-analyses guidelines. ERATS decreased length of stay, postoperative complications, and readmission. Randomized controlled trials and studies regarding cost and patient-reported outcomes (pain and patient satisfaction) are warranted.
Figure E1. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram of disposition of articles.13
Figure E2. Study attrition for meta-analysis. LOS, Length of stay; IQR, interquartile range.
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