Enhanced Recovery after Surgery (ERAS) Programs for Patients Having Colorectal Surgery: A Meta-analysis of Randomized Trials

BACKGROUND: Enhanced recovery after surgery programs have been introduced with aims of improving patient care, reducing complication rates, and shortening hospital stay following colorectal surgery. The aim of this meta-analysis was to determine whether enhanced recovery after surgery programs, when compared to traditional perioperative care, are associated with reduced primary hospital length of stay in adult patients undergoing elective colorectal surgery. METHODS: MEDLINE, EMBASE, the Cochrane Central Registry of Controlled Trials, and the reference lists were searched for relevant articles. Only randomized controlled trials comparing an enhanced recovery program with traditional postoperative care were included. RESULTS: Three of four included studies showed significantly shorter primary lengths of stay for patients enrolled in enhanced recovery programs. There was no significant difference in postoperative mortality when the two groups were compared [relative risk (RR) = 0.53; 95% CI = 0.12-2.38; test for heterogeneity, p = 0.40 and I (2) = 0], and patients in enhanced recovery programs were less likely to develop postoperative complications (RR = 0.61, 95% CI = 0.42-0.88; test for heterogeneity, p = 0.95 and I (2) = 0). AUTHORS' CONCLUSIONS: There is some evidence to suggest that enhanced recovery after surgery programs are better than traditional perioperative care, but evidence from a larger, better quality randomized controlled trial is necessary.