Purpose: Enhanced recovery program (ERP) was reported to be beneficial to patients undergoing esophageal surgery. However, evidence for ERP as a new standard perioperative pathway is insufficient. This meta-analysis aims to systematically investigate the differences between ERP and traditional care in terms of postoperative outcomes.
Methods: Studies comparing ERP with traditional care were searched in Pubmed and Ovid databases and subsequently analyzed. The primary outcome of interest was postoperative length of hospital stay (LOHS), and the secondary outcomes of interest were postoperative morbidity, mortality, and 30-day readmission rates. Statistical analysis was performed using weighted mean difference (WMD) and odds ratio (OR). Review Manager 5.3 was used to generate the eligible data.
Results: Thirteen studies with 2358 patients (1182 patients in the ERP group and 1176 patients in the control group) were included in this meta-analysis. The total LOHS (WMD -5.37; 95 % confidence interval (CI) -7.74 to -2.99; p < 0.00001) was significantly shorter in the ERP group than the control group. No statistically significant difference was found in morbidity (OR 0.78; 95 % confidence interval 0.58 to 1.05; p = 0.10), mortality (OR 0.76; 95 % CI 0.40 to 1.46; p = 0.41), and 30-day readmission rates (OR 1.01; 95 % CI 0.70 to 1.46; p = 0.97).
Conclusions: This meta-analysis suggested that the implementation of ERP led to a reduction in LOHS, while morbidity, mortality, and 30-day readmission rates did not increase compared with traditional care in patients undergoing surgery for esophageal cancer.
Keywords: Enhanced recovery program (ERP); Esophageal surgery; Meta-analysis.