Effect of the enhanced recovery after surgery protocol on recovery after laparoscopic myomectomy: a systematic review and meta-analysis

Abstract

Background: Surgery is the recommended treatment for uterine leiomyoma but it still has issues like postoperative complications and slow recovery. The enhanced recovery after surgery (ERAS) protocol could probably reduce traumatic stress and promote the rapid postoperative recovery of patients, but there are controversies for the results of different studies. This meta-analysis was performed to resolve the controversies and provide evidence for the application of ERAS in gynecology.

Methods: The PubMed, Embase, Ovid, CNKI (China), Wanfang Data (China), and Google Scholar databases were searched to recruit all studies on the application of ERAS in laparoscopic myomectomy up to November 2021. The inclusion criteria of studies was established according to the PICOS principles. the Cochrane RoB 2.0 and Newcastle-Ottawa Scale (NOS) scale were used to assess the bias of the studies, RevMan 5.3 software was used for meta-analysis.

Results: Ten studies that met the criteria were finally included with 1,441 participants. Eight of them were randomized controlled trials (RCTs) and two were cohort studies, all of them were with low level of bias. Meta-analysis showed that ERAS protocol after laparoscopic myomectomy could significantly shorten the first time getting out of bed after surgery [mean difference (MD) =-4.85; 95% confidence interval (CI): (-7.35, -2.36); P=0.0001], the first defecation time after surgery [MD =-4.69; 95% CI: (-5.68, -3.69); P<0.00001], and the postoperative hospital stay [MD =-1.32, 95% CI: (-2.08, -0.56); P=0.0007]. It could also markedly reduce the patient readmission rate [odds ratio (OR) =0.42; 95% CI: (0.23, 0.76); P=0.004], and notably reduced the incidence of complications [OR =0.37; 95% CI: (0.22, 0.61); Z=3.82; P=0.0001]. Yet, the cost of the ERAS protocol was not significantly different from that of routine care [MD =-127.76, 95% CI: (-997.19, 741.66); P=0.77].

Discussion: The application of ERAS protocol after gynecological laparoscopic myomectomy can shorten the first defecation time, first time out of bed, hospital stay, and reduce the readmission rate as well as the incidence of postoperative complications, without additional costs. But still there was heterogeneity among the studies, the topic still deserved further exploration.

Keywords: Enhanced recovery after surgery (ERAS); laparoscopy; myomectomy.

Figure 1

Literature screening flow chart.

Figure 2

Effect of the ERAS care model on the first time the patient gets out of bed after surgery (11,13,15,18,19). SD, standard deviation; IV, inverse variance; CI, confidence interval; ERAS, enhanced recovery after surgery.

Figure 3

Effect of the ERAS care model on the first defecation time of patients after surgery (11-13,15,16,18,19). SD, standard deviation; IV, inverse variance; CI, confidence interval; ERAS, enhanced recovery after surgery.

Figure 4

Effect of the ERAS care model on postoperative hospital stay of patients (11-13,15,16,18,19). SD, standard deviation; IV, inverse variance; CI, confidence interval; ERAS, enhanced recovery after surgery.

Figure 5

Cost of the ERAS care model compared to routine care (11,14,18). SD, standard deviation; IV, inverse variance; CI, confidence interval; RCTs, randomized controlled trials; ERAS, enhanced recovery after surgery.

Figure 6

Effect of the ERAS care model on the postoperative readmission rate (10,14,15,18). M-H, Mantel-Haenszel; CI, confidence interval; RCTs, randomized controlled trials; ERAS, enhanced recovery after surgery.

Figure 7

Impact of the ERAS care model on the incidence rate of postoperative complications (11-13,15,17,19). M-H, Mantel-Haenszel; CI, confidence interval; ERAS, enhanced recovery after surgery.

Figure 8

Funnel plot analysis. SE, standard error; MD, mean difference.

Figure 9

The Egger’ test. SND, standard normal deviation; CI, confidential interval.