Effect of enhanced recovery after surgery on inflammatory bowel disease surgery: A meta-analysis

BACKGROUND: The purpose of enhanced recovery after surgery (ERAS) was to reduce surgical pressure and accelerate postoperative functional recovery. Although the application of biologics in treating inflammatory bowel disease (IBD) has changed treatment strategies, most patients with IBD still require surgery. AIM: To evaluate the advantage of ERAS in IBD surgery. METHODS: The PubMed, EMBASE and Cochrane Library databases were searched from inception to March 21, 2021 to find eligible studies. The primary outcome was postoperative complications, and the secondary outcomes included operation time, time to first flatus, time to bowel movement, postoperative hospital stay and readmission. The PROSPERO registration ID of this meta-analysis is CRD42021238052. RESULTS: A total of eight studies involving 1939 patients were included in this meta-analysis. There were no differences in baseline information between the ERAS group and the non-ERAS group. After pooling up all of the data, no significant difference was found between the ERAS group and the non-ERAS group in terms of postoperative overall complications [odds ratio = 0.82, 95% confidence interval (CI) = 0.66 to 1.02, P = 0.08]. The ERAS group had a lower prevalence of anastomotic fistula (odds ratio = 0.36, 95%CI = 0.13 to 0.95, P = 0.04), less time to first flatus [mean difference (MD) = -2.03, 95%CI = -3.89 to -0.17, P = 0.03], less time to bowel movement (MD = -1.08, 95%CI = -1.60 to -0.57, P < 0.01) and shorter postoperative hospital stays (MD = -1.99, 95%CI = -3.27 to -0.71, P < 0.01) than the non-ERAS group. CONCLUSION: ERAS was effective for the quicker recovery in IBD surgery and did not lead to increased complications.