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Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis

INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols aim to optimize patient recovery after major surgery. Our study was to examine the evidence of the effectiveness of interventions designed to improve patient outcomes after radical cystectomy. DESIGN: Systematic review and meta-analysis....

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Autores principales: Peerbocus, Muaz, Wang, Zeng-Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328386/
https://www.ncbi.nlm.nih.gov/pubmed/34350137
http://dx.doi.org/10.2147/RRU.S307385
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author Peerbocus, Muaz
Wang, Zeng-Jun
author_facet Peerbocus, Muaz
Wang, Zeng-Jun
author_sort Peerbocus, Muaz
collection PubMed
description INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols aim to optimize patient recovery after major surgery. Our study was to examine the evidence of the effectiveness of interventions designed to improve patient outcomes after radical cystectomy. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Medline, Embase, Cochrane from January 2005 to January 2021 without language restrictions. ELIGIBILITY CRITERIA: Randomized and non-randomized controlled studies implementing ERAS measuring its interventions on rates of postoperative complications, 30-day readmission, length of stay (LOS) and bowel function after radical cystectomy. DATA EXTRACTION AND SYNTHESIS: Two members of the investigating team independently selected studies and evaluated bias using the Cochrane collaboration tool. Meta-analysis of all comparative studies used inversed-weighted, fixed- effects models and random effects models to pool results. Publication bias was graphically assessed using contour-enhanced funnel plots and the Egger’s test of funnel plot symmetry. RESULTS: Fifteen studies were included in our meta-analysis; we observed that ERAS decreased the time for the first bowel movement (standardized mean difference [SMD]: –1.30, 95% CI −1.90 to −0.70, P<0.00001) and shortened the length of stay (LOS) ([SMD]: –0.49, 95% CI −0.77 to −0.20, (P < 0.00001)); however, 30-day readmission (risk ratio [RR]: 0.97,95% [CI] 0.73 to 1.28, P=0.52) and the overall postoperative complication rate (risk ratio [RR]: 0.98,95% confidence interval [CI]: 0.88 to 1.09, P= 0.41) showed no significant difference.
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spelling pubmed-83283862021-08-03 Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis Peerbocus, Muaz Wang, Zeng-Jun Res Rep Urol Review INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols aim to optimize patient recovery after major surgery. Our study was to examine the evidence of the effectiveness of interventions designed to improve patient outcomes after radical cystectomy. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Medline, Embase, Cochrane from January 2005 to January 2021 without language restrictions. ELIGIBILITY CRITERIA: Randomized and non-randomized controlled studies implementing ERAS measuring its interventions on rates of postoperative complications, 30-day readmission, length of stay (LOS) and bowel function after radical cystectomy. DATA EXTRACTION AND SYNTHESIS: Two members of the investigating team independently selected studies and evaluated bias using the Cochrane collaboration tool. Meta-analysis of all comparative studies used inversed-weighted, fixed- effects models and random effects models to pool results. Publication bias was graphically assessed using contour-enhanced funnel plots and the Egger’s test of funnel plot symmetry. RESULTS: Fifteen studies were included in our meta-analysis; we observed that ERAS decreased the time for the first bowel movement (standardized mean difference [SMD]: –1.30, 95% CI −1.90 to −0.70, P<0.00001) and shortened the length of stay (LOS) ([SMD]: –0.49, 95% CI −0.77 to −0.20, (P < 0.00001)); however, 30-day readmission (risk ratio [RR]: 0.97,95% [CI] 0.73 to 1.28, P=0.52) and the overall postoperative complication rate (risk ratio [RR]: 0.98,95% confidence interval [CI]: 0.88 to 1.09, P= 0.41) showed no significant difference. Dove 2021-07-29 /pmc/articles/PMC8328386/ /pubmed/34350137 http://dx.doi.org/10.2147/RRU.S307385 Text en © 2021 Peerbocus and Wang. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Review
Peerbocus, Muaz
Wang, Zeng-Jun
Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis
title Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis
title_full Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis
title_fullStr Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis
title_full_unstemmed Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis
title_short Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis
title_sort enhanced recovery after surgery and radical cystectomy: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328386/
https://www.ncbi.nlm.nih.gov/pubmed/34350137
http://dx.doi.org/10.2147/RRU.S307385
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