Enhanced recovery after surgery protocols for the perioperative management of pediatric cleft lip and palate surgery: a systematic review and meta-analysis

Abstract

This systematic review aimed to evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) protocols for cleft lip and palate surgery in pediatric patients. A systematic search was performed in PubMed, EMBASE, Web of Science, MEDLINE, Scopus, CNKI, Wanfang, VIP, and CBM for randomized controlled trials (RCTs) and cohort studies (CS) from January 1, 2014, to August 31, 2024, to evaluate the impact of the safety and efficacy of ERAS protocols. The PRISMA statement was followed when conducting the systematic review. Review Manager 5.4 software was used to conduct the meta-analysis. A total of 17 studies involving 1870 patients were included in the analysis. Meta-analysis results revealed that, compared to the control group, the ERAS group exhibited a shorter length of stay (95%CI:3.22, -1.58, p<0.01), a lower incidence of complications (95%CI:0.14, 0.32, p<0.01), reduced postoperative opioid usage (95%CI:-0.66,-0.25, p<0.01), shorter time to initiate oral intake (95%CI:-7.08, -1.82, p<0.01), reduced postoperative pain assessments (95%CI:-1.43,-1.18, p<0.01) and elevated patient satisfaction (95%CI:2.00,11.23, p<0.01). All these differences were statistically significant, highlighting the efficacy of the ERAS protocol in enhancing postoperative recovery. The perioperative application of the ERAS concept in patients with cleft lip and palate has better efficacy and safety than the traditional concept, and it can shorten the length of hospital stay, reduce postoperative complications, reduce the dose of anaesthetics, relieve pain, advance the time of the first oral intake and accelerate the patient's recovery.

Keywords: ERAS; Enhanced recovery after surgery; Pediatric cleft lip and palate surgery.