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Published on: September 15, 2023
Efficacy of enhanced recovery programmes for cardiac surgery: a systematic review and meta-analysis
Danny F Hoogma1, Immele Meeusen2, Steve Coppens1
1Department of Anesthesiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, KU Leuven, Leuven, Belgium.
Background:
The terms fast-track (FT) and enhanced recovery after surgery (ERAS) are often mistakenly used interchangeably. Fast-track cardiac anaesthesia focuses on perioperative strategies, whereas ERAS (or enhanced recovery programme [ERP]) encompasses a wider range of strategies designed to enhance overall recovery. Evidence is needed to demonstrate the additive value of ERP above FT in cardiac surgery. We conducted a meta-analysis to investigate the comparative efficacy of ERP and FT programmes in cardiac surgery.
Methods:
We systematically searched PubMed, Embase, and Web of Science for randomised trials and prospective observational trials investigating ERP or FT programmes in cardiac surgery (up to November 16, 2024). Following PRISMA guidelines, two reviewers independently selected studies, extracted data, and assessed risk of bias. Data were pooled using a random-effects model. The primary efficacy outcome was hospital length of stay (LOS).
Results:
A total of 6368 articles were identified, of which 18 studies, with 2625 patients, were included. Compared with control, a significant reduction in hospital LOS (mean difference [95% confidence interval (CI)] -1.40 days [-2.19 to -0.61], P=0.001), ICU LOS (-13.22 h [-21.75 to -4.68], P=0.006), and ventilation time (-4.68 h [-7.85 to -1.52], P=0.008) was identified when ERP or FT programmes were implemented. ERP demonstrated an additive value above FT for hospital LOS (2.11 days [-3.52 to 0.71] vs -0.30 days [-0.88 to 0.27], respectively; P=0.003).
Conclusions:
In cardiac surgery, ERP can reduce LOS in the ICU and hospital and ventilatory time. Moreover, it is suggested that ERPs, including preoperative, intraoperative, and postoperative interventions, are preferred above only intraoperative FT strategies.
Systematic Review Protocol:
PROSPERO (CRD42022382409).
