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Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis

Acta obstetricia et gynecologica Scandinavica, 2016-04, Vol.95 (4), p.382-395 [Peer Reviewed Journal]

2015 Nordic Federation of Societies of Obstetrics and Gynecology ;2015 Nordic Federation of Societies of Obstetrics and Gynecology. ;Acta Obstetricia et Gynecologica Scandinavica © 2016 Nordic Federation of Societies of Obstetrics and Gynecology ;ISSN: 0001-6349 ;EISSN: 1600-0412 ;DOI: 10.1111/aogs.12831 ;PMID: 26613531 ;CODEN: AOGSAE

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  • Title:
    Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis
  • Author: de Groot, Jeanny J.A. ; Ament, Stephanie M.C. ; Maessen, José M.C. ; Dejong, Cornelis H.C. ; Kleijnen, Jos M.P. ; Slangen, Brigitte F.M.
  • Subjects: Abdomen ; Abdomen - surgery ; Confidence intervals ; Enhanced recovery ; enhanced recovery after surgery ; Female ; Gynecologic Surgical Procedures ; gynecology ; Hospital Mortality ; Humans ; Length of Stay ; Patient Readmission ; Perioperative Care ; Postoperative Complications ; Quantitative analysis ; Surgery
  • Is Part Of: Acta obstetricia et gynecologica Scandinavica, 2016-04, Vol.95 (4), p.382-395
  • Description: Introduction Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and meta‐analysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. Material and methods Searches were conducted using Embase, Medline, CINAHL, and the Cochrane Library up to 27 June 2014. Reference lists were screened to identify additional studies. Studies were included if at least four individual items of an enhanced recovery pathway were described. Outcomes included length of hospital stay, complication rates, readmissions, and mortality. Quantitative analysis was limited to comparative studies. Effect sizes were presented as relative risks or as mean differences (MD) with 95% confidence intervals (CI). Results Thirty‐one records, involving 16 observational studies, were included. Diversity in reported elements within studies was observed. Preoperative education, early oral intake, and early mobilization were included in all pathways. Five studies, with a high risk of bias, were eligible for quantitative analysis. Enhanced recovery pathways reduced primary (MD −1.57 days, 95% CI CI −2.94 to −0.20) and total (MD −3.05 days, 95% CI −4.87 to −1.23) length of hospital stay compared with traditional perioperative care, without an increase in complications, mortality or readmission rates. Conclusion The available evidence based on a broad range of non‐randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery.
  • Publisher: United States: Blackwell Publishing Ltd
  • Language: English;French;German
  • Identifier: ISSN: 0001-6349
    EISSN: 1600-0412
    DOI: 10.1111/aogs.12831
    PMID: 26613531
    CODEN: AOGSAE
  • Source: Journals@Ovid Open Access Journal Collection Rolling
    MEDLINE
    Alma/SFX Local Collection
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