Systematic review and meta-analysis of ERAS protocols in elderly major abdominal surgery patients
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Key Takeaway
Consider ERAS protocols for reducing hospital stay in elderly major abdominal surgery patients, noting variable compliance and limited safety data.
This is a systematic review and meta-analysis of Enhanced Recovery After Surgery (ERAS) protocols in elderly patients (≥65 years) undergoing major abdominal surgery. The analysis pooled data from 2,397 patients across 15 studies. The primary finding was that ERAS significantly reduced length of hospital stay compared to conventional care, with a mean difference of -3.31 days (95% CI: -3.74 to -2.88).
The authors also synthesized evidence on secondary outcomes, including total complication rate, 30-day mortality, and 30-day readmission rate. The review did not report pooled effect sizes for these secondary outcomes. The practice relevance noted is that ERAS pathways consistently included early feeding, early mobilization, and reduced routine tube use.
Key limitations acknowledged by the authors include variable reporting of protocol details and compliance. Overall compliance was reported in only 6 of the 15 studies, with a range of 42% to 89.6%. The authors do not report safety data, such as adverse events, serious adverse events, discontinuations, or tolerability.
The certainty of the evidence and causality are not explicitly stated in the source. The findings suggest ERAS may be beneficial for reducing hospital stay in this population, but the variable compliance and lack of safety data limit strong conclusions.
View Original Abstract ↓
BackgroundEnhanced Recovery After Surgery (ERAS) protocols have been widely adopted in perioperative care, but their effectiveness and safety in elderly patients undergoing major abdominal surgery remain subjects of ongoing investigation. To systematically evaluate the effectiveness of ERAS protocols compared with conventional care in elderly patients (≥65 years) undergoing major abdominal surgery.MethodsA systematic search was conducted in PubMed, Cochrane Library, Embase, and Web of Science from inception to December 2024. Randomized controlled trials (RCTs) and prospective cohort studies comparing ERAS with conventional care in elderly patients undergoing major abdominal surgery were included. The primary outcome was length of hospital stay (LOS). Secondary outcomes included total complication rate, 30-day mortality, and 30-day readmission rate. ERAS components, protocol compliance, baseline characteristics, and complication definitions were extracted when available. Meta-analyses were performed using random-effects models with subgroup and sensitivity analyses.ResultsFifteen studies (6 RCTs and 9 prospective cohort studies) involving 2,397 patients were included. Most studies evaluated colorectal surgery, while two involved hepatectomy and two involved gastrectomy. ERAS pathways consistently included early feeding, early mobilization, and reduced routine tube use, but reporting of protocol details and compliance was variable; overall compliance was reported in 6 of 15 studies (range 42%–89.6%). ERAS significantly reduced LOS compared with conventional care (MD = −3.31 days, 95% CI: −3.74 to −2.88, P
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