Meta-analysis of ERAS Protocols and their Impact on Postoperative Outcomes

Author(s): Chathura Egoda Arachchilage and Kuda Galketiya

In recent years, the Enhanced Recovery After Surgery (ERAS) protocols have become an evidence-based practice to improve postoperative recovery, reduce complications, and reduce costs in healthcare. To summarize data from RCTs and observational studies regarding the effectiveness of the protocols, especially in colorectal and hepatobiliary surgery, this meta-analysis is conducted. A secondary type of outcome examined included; the length of stay in the healthcare facility, resulting postoperative complications, recovery period, readmission rates, and overall cost- effectiveness. The findings showed that patients in the ERAS group have on average 25 percent shorter stay in hospital compared to those that received standard care. Key ERAS interventions including early mobilization, optimization of fluid and nutrition management as well as multimodal analgesia have reduced the physiological stress of surgery and consequently improved recovery time. In addition, the protocols are associated with reductions of 15–20 percent in postoperative complications such as infections and DVT, common issues that delay recovery and increase healthcare costs. Finally, the meta-analysis also shows that the protocols have a significant cost saving, and the mean cost per patient in the ERAS group is around 13 to 15% lower than in the standard care group, which is primarily due to reduced stays in the healthcare facility and reduced complications. The beneficial features of ERAS as compared to the Australian healthcare system, which was one of the first to adopt ERAS, also indicate a wider range of applicability and a potential cost advantage, as well as improvement of outcomes. The findings of this study suggest that the protocols are a widely effective strategy to improve postoperative recovery and decrease complications, as well as promote cost efficiencies in high-income as well as low to middle-income countries. The findings display the ability of the protocols to improve surgical outcomes across a variety of setting types worldwide.