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Meta-Analysis
. 2023 Oct 3:13:04114.
doi: 10.7189/jogh.13.04114.

Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS)

Aya M Riad  1 , Aisling Barry  1 , Stephen R Knight  2 , Carlie J Arbaugh  3 , Parvez D Haque  4 , Thomas G Weiser  3 , Ewen M Harrison  2
Affiliations
Meta-Analysis

Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS)

Aya M Riad et al. J Glob Health. .

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols have largely been incorporated into practice in high-income settings due to proven improvement in perioperative outcomes. We aimed to review the implementation of ERAS protocols and other perioperative optimisation strategies in low- and middle-income countries (LMICs) and their impact on length of hospital stay (LOS).

Methods: We searched MEDLINE, PubMed, Global Health (CABI), WHO Global Index Medicus, Index Medicus, and Latin American and Caribbean Health Sciences Literature (LILACS) for studies incorporating ERAS or other prehabilitation approaches in LMICs. We conducted a pooled analysis of LOS using a random-effects model to evaluate the impact of such programs. This systematic review was pre-registered on PROSPERO.

Results: We screened 1205 studies and included 70 for a full-text review; six were eligible for inclusion and five for quantitative analysis, two of which were randomised controlled trials. ERAS was compared to routine practice in all included studies, while none implemented prehabilitation or other preoperative optimisation strategies. Pooled analysis of 290 patients showed reduced LOS in the ERAS group with a standardised mean difference of -2.18 (95% confidence interval (CI) = -4.13, -.0.05, P < 0.01). The prediction interval was wide (95% CI = -7.85, 3.48) with substantial heterogeneity (I2 = 94%).

Conclusions: Perioperative optimisation is feasible in LMICs and appears to reduce LOS, despite high levels of between-study heterogeneity. There is a need for high-quality data on perioperative practice in LMICs and supplementary qualitative analysis to further understand barriers to perioperative optimisation implementation.

Registration: PROSPERO: CRD42021279053.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Forest plot of pooled length of stay analysis (measured in days).
See this image and copyright information in PMC

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References

    1. Adams HA, Hempelmann G.The endocrine stress reaction in anesthesia and surgery–origin and significance. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie. Anasthesiol Intensivmed Notfallmed Schmerzther. 1991;26:294-305. 10.1055/s-2007-1000588 - DOI - PubMed
    1. Rosenberg J, Kehlet H.Surgical physiopathology. New results of importance for optimization of the postoperative course. Ugeskr Laeger. 2001;163:908-12. - PubMed
    1. Nygren J, Hausel J, Kehlet H, Revhaug A, Lassen K, Dejong C, et al. A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery. Clin Nutr. 2005;24:455-61. 10.1016/j.clnu.2005.02.003 - DOI - PubMed
    1. Bardram L, Funch-Jensen P, Jensen P, Kehlet H, Crawford M.Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet. 1995;345:763-4. 10.1016/S0140-6736(95)90643-6 - DOI - PubMed
    1. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CHC, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466-77. 10.1016/j.clnu.2005.02.002 - DOI - PubMed

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