Effectiveness of Enhanced Recovery After Surgery (ERAS) in Promoting Better Recovery in Patients Undergoing Hysterectomy for Benign Gynecologic Diseases: A Systematic Review and Meta-Analysis

Abstract

Background: Enhanced recovery after surgery (ERAS) protocol is a multidisciplinary approach to care for patients who undergoes surgery. Initially used with colorectal surgery, ERAS intervention has gradually been used in other major surgical specialities for its excellent outcomes such as early recovery and shortened length of hospital stay. However, there is a lack of systematic review exploring the effectiveness of ERAS in hysterectomy in promoting better recovery. Objectives: To synthesise the best available evidence of the effectiveness of ERAS intervention in promoting better recovery (shortened length of hospital stay as primary outcomes, lower readmission and complication rates as secondary outcomes) among patients undergoing hysterectomy due to benign conditions as compared to conventional perioperative care. Design: A systematic review and meta-analysis. Methods: Seven electronic databases including PubMed, CENTRAL, CINAHL, EMBASE, Scopus, Web of Science and ProQuest Dissertations and Theses Global were searched systematically. Randomized controlled trials, cohort studies or quasi-experimental studies examining the effects of ERAS for women diagnosed with benign gynecologic diseases and underwent either abdominal or laparoscopic hysterectomy and published in English without year limitation were included. Two reviewers independently conducted database search, data extraction and methodological quality assessment. Meta-analyses were performed for all outcomes. The overall quality of evidence was assessed using GRADE. Results: Nine studies involving 1308 patients were included in this review. Meta-analysis showed a statistically significant reduction in length of hospital stay, (SMD=-0.76, 95% CI [- 1.06, -0.46], Z=4.72, p<.00001), readmission rate (RR= 0.65, 95% CI [0.44-0.96]; Z= 2.16, p=.03) and the complication rate (RR= 0.61, 95% CI [0.48-0.77]; Z= 4.17, p<0.0001). Conclusion and Implications: The effectiveness of ERAS protocol in improving recovery among patients who undergo an abdominal and laparoscopic hysterectomy indicates that hospitals could adopt the protocol to improve patients’ health and wellbeing. Future studies can focus more on standardising the protocol’s elements.