Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Many enhanced recovery after surgery (ERAS) guidelines have already been established in several kinds of surgeries. But due to concerns of the specific complications, it has not yet been considered the standard of care in liver surgery. OBJECTIVE: The aim of this review is to assess the effect of ERAS in patients undergoing liver surgery. METHODS: EMBASE, CNKI, PubMed, and the Cochrane Database were searched for randomized controlled trials (RCTs) comparing ERAS with conventional care in patients undergoing liver surgery. Subgroup meta-analysis between laparoscopic and open surgical approaches to liver resection was also conducted. RESULTS: Seven RCTs were included, representing 996 patients. Length of stay (LOS) (MD −3.17, 95% CI: −3.99 to −2.35, P < .00001, I(2) = 89%) and time to first flatus (MD −0.9, 95% CI: −1.36 to −0.45, P = .0001, I(2) = 98%) were both reduced in the ERAS group. There were also fewer complications in the ERAS group (OR 0.52, 95% CI: 0.37–0.72, P < .0001, I(2) = 0%). CONCLUSION: The ERAS program can obviously enhance short-term recovery after liver resection. It is safe and worthwhile. A specific ERAS guideline for liver resection is recommended.