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. 2021 Nov;10(11):3034-3045.
doi: 10.21037/tp-21-457.

Systematic review and meta-analysis of the effects of the perioperative enhanced recovery after surgery concept on the surgical treatment of acute appendicitis in children

Anping Zhang #  1 , Hao Lu #  2 , Fangfang Chen  1 , You Wu  3 , Liqiong Luo  2 , Siyi Sun  1
Affiliations

Systematic review and meta-analysis of the effects of the perioperative enhanced recovery after surgery concept on the surgical treatment of acute appendicitis in children

Anping Zhang et al. Transl Pediatr. 2021 Nov.

Abstract

Background: Enhanced recovery after surgery (ERAS), as a new concept in surgery, has dramatically changed the mode of perioperative treatment for children with acute appendicitis.

Methods: The retrieval strategy developed by the Cochrane Collaboration was conducted using the CNKI database, Wanfang Medical Network, PubMed, EBSCO, Medline, and Cochrane database by combining subject headings and free words. A review of the randomized controlled trials on the use of the ERAS concept in the perioperative treatment of acute appendicitis in children was conducted between the establishment of the database and May 15, 2021. Keywords included enhanced recovery after surgery, fast track surgery, ERAS, FTS, child, infant, and appendicitis. The quality of the literature was evaluated according to the RevMan 5.3 software provided by the Cochrane Collaboration.

Results: Five randomized controlled trials on ERAS in children with acute appendicitis were finally included. The heterogeneity of postoperative stay time was tested in 4 studies using continuous variables, with Chi-squared test (Chi2) =221.52, degree of freedom (df) =3, I2=99%>50%. An overall analysis using a random effects model showed that the ERAS group was significantly different compared to the control group [Z=5.26; mean difference (MD) =-1.65; 95% CI: -2.27 to -1.03; P<0.00001]. The heterogeneity of the readmission rate was tested in 5 studies using dichotomous variables, with Chi2=5.11, df =3, I2=41%<50%, P=0.91. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group [Z=0.80; odds ratio (OR) =1.16; 95% CI: 0.81 to 1.66; P=0.42]. The heterogeneity of the recurrence rate was tested in 4 studies using dichotomous variables, with Chi2=3.73, df =3, I2=20%<50%, P=0.29. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group (Z=1.14; OR =0.76; 95% CI: 0.47 to 1.22; P=0.26).

Discussion: The results of the meta-analysis confirmed that perioperative application of the ERAS concept in children with acute appendicitis can promote the rehabilitation of children, reduce the postoperative stay time, and reduce the readmission rate and reoperation rate.

Keywords: Enhanced recovery after surgery (ERAS); acute appendicitis in children; meta-analysis; perioperative period; treatment.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tp-21-457). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Literature screening process.
Figure 2
Figure 2
GRADE classification results.
Figure 3
Figure 3
Literature risk of bias evaluation results.
Figure 4
Figure 4
The bias-risk assessment diagram of the included articles.
Figure 5
Figure 5
Forest plot of the fixed effects model for postoperative stay time.
Figure 6
Figure 6
Forest plot of the fixed effects model for postoperative incision infection rate.
Figure 7
Figure 7
Funnel plot of postoperative incision infection rate.
Figure 8
Figure 8
Forest plot of the fixed effects model for incidence of postoperative residual abdominal abscess.
Figure 9
Figure 9
Funnel plot of incidence of postoperative residual abdominal abscess.
Figure 10
Figure 10
Forest plot of the fixed effects model for complication rate.
Figure 11
Figure 11
Funnel plot of complication rate.
Figure 12
Figure 12
Forest plot of the fixed effects model for readmission rate.
Figure 13
Figure 13
Funnel plot of readmission rate.
Figure 14
Figure 14
Forest plot of the fixed effects model for recurrence rate.
Figure 15
Figure 15
Funnel plot of recurrence rate.
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