Effectiveness of Enhanced Recovery After Surgery (ERAS) in the Improvement of Clinical Outcomes of Paediatric Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Enhanced Recovery After Surgery (ERAS) is a multimodal approach that has been adopted over the past 20 years to reduce surgical stress responses in various surgical specialities. While some studies have evaluated its effects when used in pediatric surgery, no systematic review has synthesised the effects of ERAS on pediatric abdominal surgery. Aims: To synthesise the best available evidence of the effectiveness of ERAS in reducing the length of hospital stay (LOS) , time to oral intake, time to stool, rates of complications and 30- day readmissions in pediatric patients undergoing abdominal surgery as compared to traditional perioperative outcomes. Methods: We searched six electronic databases of CINAHL, CENTRAL, EMBASE, ProQuest Dissertations and Thesis Global, PubMed and Scopus. English-language quantitative studies examining effectiveness of ERAS on pediatric patients undergoing abdominal surgery, from inception until January 2021 were eligible. Two reviewers independently conducted database search, data extraction and assessment of methodological quality. A systematic review and meta-analyses were performed. Sensitivity and subgroup analyses were conducted. Results: We included twelve studies. The pooled standardized mean difference for LOS, time to oral intake and time to stool were -1.96(95%CI-2.75--1.17, Z=4.87, p<0.00001), - 1.18(95%CI-1.56--0.81, Z=4.48, p<0.00001) and -4.19(95%CI-6.37--2.02), Z=3.78, p=0.0002) respectively. The pooled risk ratio for postoperative complications and 30-day readmission were 0.50(95%CI0.30-0.83, Z=2.68, p=0.007) and 0.64(95%CI0.42-0.99, Z=2.02, p=0.04) respectively. Subgroup analyses for continuous outcomes suggested that ERAS is more effective in children than adolescents. For time to stool, ERAS is more effective in gastrointestinal surgery than colorectal surgery. Conclusion: ERAS was effective in improving clinical and outcomes for pediatric patients undergoing abdominal surgery, implying that ERAS can be adopted by other pediatric surgical settings. Well-designed trials with large sample size are needed to ensure robustness of evidence.