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Enhanced recovery in colorectal resections: a systematic review and meta‐analysis 1
Author(s) -
Walter C. J.,
Collin J.,
Dumville J. C.,
Drew P. J.,
Monson J. R.
Publication year - 2009
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2009.01789.x
Subject(s) - medicine , meta analysis , confidence interval , randomized controlled trial , medline , inclusion and exclusion criteria , data extraction , relative risk , cochrane library , surgery , pathology , alternative medicine , political science , law
Objective The study aimed to produce a comprehensive up‐to‐date meta‐analysis exploring the safety and efficacy of enhanced recovery (ER) programmes after colorectal resection. Method Key‐word and MESH‐heading searches of MEDLINE, EMBASE and the Cochrane Databases from 1966 to February 2007 were used to identify all available randomized and clinical controlled studies. Two independent reviewers assessed studies for inclusion and exclusion based on methodological quality criteria prior to undertaking data extraction. Summary estimates of treatment effects using a fixed effect model were produced with RevMan 1.0.2, using weighted means for length‐of‐stay data and relative risks of morbidity, mortality and readmission rates. Results Analysis of four papers including 376 patients demonstrated primary and total length‐of‐stays (primary + readmission length‐of‐stay) to be significantly reduced ( P < 0.001) with ER programmes [weighted mean differences of −3.64 days (95% confidence interval, 95% CI −4.98 to −2.29) and −3.75 days (95% CI−5.11 to −2.40)]. Analysis of controlled clinical trial data showed morbidity rates to be reduced and readmission rates increased. These trends were not seen amongst the randomized controlled trial data. There were no differences in mortality rates. Conclusion Enhanced recovery programmes after colorectal resections reduce length‐of‐stay and may reduce 30 days morbidity and increase 30 days readmission without increasing mortality.