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Enhanced Recovery after Pediatric Cardiac Surgery: A Meta-Analysis
Osama Abu-Shawer1, Abdel-Rahman E'mar2, Abdel-Rahman Jaber3
1Anesthesiology and Perioperative Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.
Insights
Enhanced Recovery After Surgery (ERAS) protocols in pediatric cardiac surgery reduce ICU length of stay but do not significantly alter complication rates. Further research is needed to confirm efficacy and long-term benefits.
Area of Science:
- Pediatric Cardiac Surgery
- Enhanced Recovery After Surgery (ERAS) Protocols
- Systematic Review and Meta-Analysis
Background:
- Enhanced Recovery After Surgery (ERAS) protocols are established multimodal perioperative care pathways.
- Application of ERAS in pediatric cardiac surgery is emerging.
- This study systematically reviews the efficacy of ERAS in pediatric cardiac surgery.
Purpose of the Study:
- To systematically review the current evidence on the efficacy of ERAS protocols in pediatric cardiac surgery.
- To evaluate the impact of ERAS on postoperative outcomes in pediatric cardiac surgery patients.
- To identify gaps in the existing literature regarding ERAS implementation in this population.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- Searched multiple databases (PubMed, Cochrane, Scopus, etc.) for comparative studies from 2000-2024.
- Included five studies (3 RCTs, 1 cohort, 1 case-control) with 1,008 pediatric cardiac surgery patients.
Main Results:
- ERAS implementation significantly reduced Intensive Care Unit (ICU) length of stay (MD = -1.441 days, p=0.016).
- No significant difference in postoperative complication rates between ERAS and standard care groups (OR = 0.889, p=0.516).
- Heterogeneity was high for ICU length of stay (I²=98.26%).
Conclusions:
- ERAS protocols show promise for improving short-term outcomes, specifically reducing ICU stay, in pediatric cardiac surgery.
- Current evidence is limited by the small number of studies and heterogeneity.
- Further high-quality, multicenter randomized controlled trials are necessary to fully assess ERAS efficacy and long-term outcomes.
Background:
The Enhanced Recovery After Surgery (ERAS) protocols are a set of steps taken before, during, and after surgery to improve patient care and outcomes. While ERAS is well known for its benefits in various surgeries, its application in pediatric cardiac surgery is relatively new. With the recent emergence of studies on its implementation in pediatric cardiac surgery, this study is the first to systematically review the current evidence on the efficacy of ERAS in the field.
Methods:
A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently searched PubMed, Cochrane, Google Scholar, Web of Science, Embase, and Scopus databases for comparative studies with control groups that described the use of ERAS in all types of pediatric cardiac surgeries from 2000 to 2024. The data collected included study design, patient demographics, elements of the ERAS protocols, and postoperative outcomes. The random-effects model was used to calculate the pooled odds ratios (ORs) and mean differences (MDs) with the corresponding confidence intervals (CIs) for proportional and continuous variables, respectively.
Results:
Five studies, involving 1,008 patients, were included in the final analysis: three randomized controlled trials (RCTs), one retrospective cohort, and one case-control study. The ERAS protocols were applied in 430 (43%) patients, and standard perioperative care was applied in 578 (57%) patients. The analysis revealed that implementing the ERAS protocol significantly reduced ICU length of stay ( I 2 = 98.26%; MD = -1.441; 95% CI: -2.610 to -0.273; p = 0.016). The ERAS group had a comparable rate of postoperative complications to the standard care group ( I 2 = 15.3%; OR: 0.889; 95% CI: 0.622-1.269; p = 0.516).
Conclusions:
The ERAS protocols in pediatric cardiac surgery appear to be safe and effective in improving certain short-term outcomes. However, evidence is limited due to the small number of studies. Further multicenter RCTs that fully incorporate the ERAS protocol elements and assess both immediate and long-term outcomes are needed.
