Effect of ERAS pathway nursing on postoperative rehabilitation of patients undergoing gastrointestinal surgery: a meta-analysis

Abstract

Background: This study aimed to systematically evaluate the impact of the Enhanced Recovery After Surgery (ERAS) pathway on postoperative outcomes-including hospital length of stay, complication rates, readmission, reoperation, and mortality-in patients undergoing gastrointestinal surgery, to provide evidence-based guidance for clinical practice.

Methods: We systematically searched PubMed, Cochrane Library, Embase, Web of Science and Scopus databases for randomized controlled trials (RCTs) and cohort studies on ERAS pathway in postoperative rehabilitation. Thirteen studies comprising a total of 5,603 patients were included. Literature screening and quality assessment followed the standards of Cochrane Collaboration and Newcastle-Ottawa scales. Statistical analysis was performed using R software to calculate the relative risk (RR), mean difference (MD) with 95% confidence interval (CI), and heterogeneity through the I² statistic, with significance set at P < 0.05. This systematic review and meta-analysis has been registered in the PROSPERO database (ID: CRD42024608876).

Results: The ERAS pathway significantly shortened the postoperative hospital stay (MD = -3.16, 95% CI [-4.10, -2.21], P < 0.01) and reduced the incidence of postoperative complications (RR = 0.70, 95% CI [0.58, 0.84], P < 0.01). It also significantly reduced the readmission rates (RR = 0.75, 95% CI [0.58, 0.96], P = 0.02). However, there was no statistically significant difference in the impact of ERAS pathway on reoperation rate and mortality (RR = 0.59, 95% CI [0.01, 30.14], P = 0.62).

Conclusions: ERAS protocols are associated with improved postoperative recovery in gastrointestinal surgery, including shorter hospital stays and reduced complication and readmission rates. Although no significant effects were found for reoperation or mortality, the overall evidence supports the broader clinical adoption of ERAS, with a need for further high-quality studies to address remaining uncertainties.

Keywords: Enhanced recovery after surgery; Gastrointestinal surgical procedures; Meta-analysis; Postoperative care; Postoperative complications; Systematic review.

Fig. 1

Flow chart of literature screening process

Fig. 2

Forest plot comparing postoperative hospital stay (days) between ERAS and control groups. Squares represent point estimates for individual studies, with horizontal lines indicating 95% confidence intervals. The diamond shows the pooled mean difference (MD) with 95% CI. ERAS: Enhanced Recovery After Surgery

Fig. 3

Forest plot comparing postoperative complication rates between ERAS and control groups. Each square represents the risk ratio (RR) for an individual study, with horizontal lines denoting 95% confidence intervals (CIs). The diamond displays the pooled RR with 95% CI using a random-effects model. The vertical line at RR = 1 indicates no difference between groups. ERAS: Enhanced Recovery After Surgery

Fig. 4

Forest plot comparing postoperative readmission rates between ERAS and control groups. Each square represents the risk ratio (RR) for an individual study, with horizontal lines denoting 95% confidence intervals (CIs). The diamond displays the pooled RR with 95% CI using a random-effects model. The vertical line at RR = 1 indicates no difference between groups. ERAS: Enhanced Recovery After Surgery

Fig. 5

Forest plot comparing postoperative reoperation rates between ERAS and control groups. Each square represents the risk ratio (RR) for an individual study, with horizontal lines denoting 95% confidence intervals (CIs). The diamond displays the pooled RR with 95% CI using a random-effects model. The vertical line at RR = 1 indicates no difference between groups. ERAS: Enhanced Recovery After Surgery

Fig. 6

Forest plot of postoperative mortality of two groups of patients after ERAS pathway nursing intervention

Fig. 7

Funnel plot assessing publication bias for studies reporting postoperative hospital stay. Each point represents an individual study’s effect size (mean difference) plotted against its standard error. The vertical line indicates the pooled effect estimate, while the diagonal lines show the expected 95% confidence interval boundaries under the assumption of no publication bias. Symmetrical distribution of points around the pooled estimate suggests minimal publication bias

Fig. 8

Sensitivity analysis of hospital stay. Each row represents the pooled risk ratio (RR) when excluding one study sequentially. The central diamond indicates the overall RR with 95% CI from the primary analysis. Horizontal lines show the range of RR estimates after each exclusion, demonstrating robustness of findings