Enhanced recovery after surgery protocols and emergency surgery: a systematic review and meta‐analysis of randomized controlled trials

Abstract Background This systematic review and meta‐analysis seeks to assess the modified protocols used and patient outcomes when enhanced recovery after surgery (ERAS) protocols are utilized in an emergency setting. Methods PubMed, MEDLINE, EMBASE and Cochrane Central Registry of Controlled Trials were comprehensively searched until 13 March 2023. The Cochrane Risk of Bias Assessment Tool was used to assess for bias, along with funnel plot asymmetry. We present log risk ratios for dichotomous variables and raw mean differences for continuous variables. Results Seven randomized trials were included, comprising 573 patients. Results of the primary outcomes when comparing ERAS to standard care are as follows; withdrawal of nasogastric tube (raw mean difference −1.87 CI: −2.386 to −1.359), time to first liquid diet (raw mean difference −2.56 CI: −3.435 to −1.669), time to first solid diet (raw mean difference −2.35 CI: −2.933 to −1.76), time to first flatus (raw mean difference −2.73 CI: −5.726 to 0.257), time to first stool passed (raw mean difference −1.83 CI: −2.307 to −1.349), time to removal of drains (raw mean difference −3.23 CI: −3.609 to −2.852), time to removal of urinary catheter (raw mean difference −1.57 CI: −3.472 to 0.334), mean pain score (raw mean difference −1.79 CI: −2.222 to −1.351) and length of hospital stay (raw mean difference −3.16 CI: −3.688 to −2.63). Conclusions The adoption of ERAS protocols in an emergency surgery setting was observed to enhance patient recovery, while not indicating any statistically significant increase in adverse outcomes.