Key result
The enhanced recovery program in colorectal surgery reduced overall postoperative morbidity (RR 0.66) compared to standard care, though the certainty of evidence was very low.
Why the study?
Multimodal enhanced recovery programs represent a new paradigm in perioperative care, but the certainty of evidence for their effectiveness and safety in elective colorectal surgery needed evaluation.
Does a multimodal perioperative care program reduce morbidity and postoperative mortality in adults undergoing elective colorectal surgery?
Systematic Review
Does a multimodal perioperative care program reduce morbidity and postoperative mortality in adults undergoing elective colorectal surgery?
The enhanced recovery program in colorectal surgery is effective in reducing global postoperative morbidity and hospital stay, though the certainty of the evidence is very low.
Answers are grounded in this paper and cite their sources.
Very low-certainty evidence suggests ERAS reduces morbidity and LOS in colorectal surgery; leaves open need for rigorous trials before practice change.
Introduction: Multimodal enhanced recovery programs are a new paradigm in perioperative care. Objective: To evaluate the certainty of evidence pertaining to the effectiveness and safety of the multimodal perioperative care program in elective colorectal surgery. Data source: A search was conducted in the Medline, EMBASE, and Cochrane databases, up until February 2020. Eligibility criteria: Systematic reviews that take into account the perioperative multimodal program in patients with an indication for colorectal surgery were included. The primary outcomes were morbidity and postoperative deaths. The secondary outcome was hospital length of stay. Study quality and synthesis method: The reviews were evaluated with AMSTAR-2 and the certainty of the evidence with the GRADE methodology. The findings are presented with measures of frequency, risk estimators, or differences. Results: Six systematic reviews of clinical trials with medium and high quality in AMSTAR-2 were included. Morbidity was reduced between 16 and 48%. Studies are inconclusive regarding postoperative mortality. Hospital length of stay was reduced by an average of 2.5 days (p <0.05). The certainty of the body of evidence is very low. Limitations: The effect of the program, depending on the combination of elements, is not clear. Conclusions and implications: Despite the proven evidence that the program is effective in reducing global postoperative morbidity and hospital stay, the body of evidence is of very low quality. Consequently, results may change with new evidence and further research is required.
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Acevedo et al. (2020) conducted a systematic review in Elective colorectal surgery. Enhanced recovery program (ERAS) vs. Standard care was evaluated on Overall postoperative morbidity (RR 0.66, 95% CI 0.54-0.80). The enhanced recovery program in colorectal surgery reduced overall postoperative morbidity (RR 0.66) compared to standard care, though the certainty of evidence was very low.
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