The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials

The enhanced recovery after surgery (ERAS) program aims to attenuate the surgical stress response and decrease postoperative complications. It has increasingly replaced conventional approaches in surgical care. To evaluate the benefits and harms of the ERAS program compared to conventional care in patients undergoing liver surgery. We searched the MEDLINE, PubMed, EMBASE and Cochrane databases. All RCTs that compared the ERAS program with conventional care were selected. Four RCTs were eligible for analysis, which included 634 patients (309 ERAS vs. 325 conventional). Overall morbidity (RR 0.67; 95 % CI 0.48-0.92; p = 0.01), primary length of stay (WMD -2.71; 95 % CI -3.43 to -1.99; p < 0.00001), total length of stay (WMD -2.10; 95 % CI -3.96 to -0.24; p = 0.03), time of functional recovery (WMD -2.30; 95 % CI -3.77 to -0.83; p = 0.002), and time to first flatus (SMD, -0.52; 95 % CI -0.69 to -0.35; p < 0.00001) were significantly shortened in the ERAS group. Quality of life was also better in the ERAS group. However, no significant differences were noted in mortality, readmission rates, operative time and intraoperative blood loss. The ERAS Program for liver surgery significantly reduced overall morbidity rates, accelerated functional recovery, and shortened the primary and total hospital stay without compromising readmission rates. Therefore, ERAS appears to be safe and effective. However, the conclusions are limited because of the low methodological quality of the analyzed studies. Further studies are needed to provide more solid evidence.