Yulian Chen1, Mingru Fu2, Guifen Huang2, Jiao Chen3. 1. Reproductive Center, Haikou Maternal and Child Health Hospital, Haikou, China. 2. Department of Gynecology, Danzhou People's Hospital, Danzhou, China. 3. Operating Room, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.
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. 2022 Gland Surgery. All rights reserved.
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. 2022 Gland Surgery. All rights reserved.
Entities:
Keywords:
Enhanced recovery after surgery (ERAS); laparoscopy; myomectomy
Authors: Janani Thillainadesan; Minna F Yumol; Michael Suen; Sarah Hilmer; Vasi Naganathan Journal: Dis Colon Rectum Date: 2021-08-01 Impact factor: 4.585
Authors: K Mortensen; M Nilsson; K Slim; M Schäfer; C Mariette; M Braga; F Carli; N Demartines; S M Griffin; K Lassen Journal: Br J Surg Date: 2014-07-21 Impact factor: 6.939
Authors: Lena Wijk; Ruzan Udumyan; Basile Pache; Alon D Altman; Laura L Williams; Kevin M Elias; Jake McGee; Tiffany Wells; Leah Gramlich; Kevin Holcomb; Chahin Achtari; Olle Ljungqvist; Sean C Dowdy; Gregg Nelson Journal: Am J Obstet Gynecol Date: 2019-04-30 Impact factor: 8.661
Authors: Teresa K L Boitano; Haller J Smith; Tullia Rushton; Mary C Johnston; Prentiss Lawson; Charles A Leath; Anisa Xhaja; Meredith P Guthrie; J Michael Straughn Journal: Gynecol Oncol Date: 2018-09-21 Impact factor: 5.482