Impact of Enhanced Recovery After Surgery (ERAS) guidelines implementation in deep infiltrating endometriosis...

The complexity of surgical management in women with deep infiltrating endometriosis (DIE) demands the optimisation of perioperative care protocols to ensure optimal postoperative outcomes.

This meta-analysis evaluates the effectiveness of Enhanced Recovery After Surgery (ERAS) protocols compared to conventional perioperative care in patients undergoing surgery for DIE.

A systematic literature search was conducted in Medline, Scopus, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov databases from inception till August 2024. Meta-analysis was performed with RevMan 5.4 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020), with mean differences (MDs), pooled risk ratios (RR) and random-effects model. Quality assessment was performed using the Risk of Bias in Non-randomised Studies of Interventions and Risk of Bias tools.

Primary outcomes assessed were postoperative length of hospital stay and readmission rates. Secondary outcomes included Clavien-Dindo grade I-II and grade III or higher complication rates.

Four comparative studies were included, encompassing a total of 1,662 patients. ERAS protocols significantly reduced the mean length of hospital stay [MD: -2.88 days; 95% confidence interval (CI): -5.34 to -0.41; P=0.02] without increasing readmission rates (RR: 1.13; 95% CI: 0.75-1.73; P=0.55). No significant differences were observed in Clavien-Dindo grade I-II complications (RR: 0.75; 95% CI: 0.49-1.16; P=0.20) or grade III or higher complications rates (RR: 0.60; 95% CI: 0.27-1.33; P=0.21).

ERAS protocols appear to reduce the length of hospital stay without increasing complications or readmissions in DIE surgery. However, further large-scale randomised studies still needed to be conducted to confirm these findings.

The application of ERAS protocols is associated with better postoperative outcomes in patients undergoing major surgeries for DIE.