Methodological quality in guidelines for enhanced recovery after surgery was suboptimal

Area of Science:

• Perioperative Medicine
• Clinical Guideline Development
• Evidence-Based Practice

Background:

• Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient recovery.
• Standardized guidelines are crucial for consistent implementation of ERAS pathways.
• Methodological quality assessment of existing ERAS guidelines is essential for their effective use.

Purpose of the Study:

• To critically appraise the methodological quality of current Enhanced Recovery After Surgery (ERAS) guidelines.
• To assess the concordance and consistency among recommendations in ERAS guidelines.
• To identify areas for improvement in the development of future ERAS guidelines.

Main Methods:

• Systematic literature search across major databases (PubMed, Embase, Web of Science, Google Scholar) and guideline repositories.
• Independent assessment of 23 identified ERAS guidelines by four reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.
• Calculation of mean AGREE II domain scores, recommendation strength, and level of evidence, with inter-reviewer agreement assessed via intraclass correlation coefficient.

Main Results:

• A total of 23 ERAS guidelines were evaluated from 7,127 records, with good overall inter-reviewer agreement (ICC=0.92).
• Mean AGREE II domain scores revealed significant variability, with the lowest scores for Applicability (37.2%) and Stakeholder Involvement (40.7%).
• Only 2 out of 23 guidelines were deemed applicable for direct clinical use without modifications, highlighting quality concerns.

Conclusions:

• The methodological quality of existing ERAS guidelines is generally low and inconsistent.
• Future ERAS guideline development should rigorously employ the AGREE II instrument and the GRADE system.
• Adherence to standardized development processes will enhance the reliability and clinical utility of ERAS guidelines.