title: Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Enhanced recovery after surgery programs in colorectal surgery aim to attenuate the surgical stress response, reduce complications and shorten hospital stay.
  
  
  OBJECTIVE
  This study aimed to assess the safety and efficacy of enhanced recovery after surgery programs in colorectal surgery in comparison with traditional care.
  
  
  METHODS
  PubMed, Embase, and Cochrane databases were electronically searched (date range, January 1966 to July 2012).
  
  
  METHODS
  Randomized controlled trials were selected that compared enhanced recovery after surgery programs with traditional care in elective colorectal surgery.
  
  
  METHODS
  Articles were reviewed independently by 2 reviewers, who extracted the data and assessed the quality of the included studies. The outcome measures were analyzed, and the quality of evidence for each outcome was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation system.
  
  
  METHODS
  The primary outcome measures were primary and total postoperative hospital stay, readmission rates, total postoperative complications (including general and surgical complications), and mortality.
  
  
  RESULTS
  Thirteen studies (total, 1910 patients) were included in the meta-analysis. In comparison with traditional care, enhanced recovery after surgery programs were associated with significantly decreased primary hospital stay (weighted mean difference, -2.44 days; 95% CI, -3.06 to -1.83 days; p < 0.00001), total hospital stay (weighted mean difference, -2.39 days; 95% CI, -3.70 to -1.09 days; p = 0.0003), total complications (relative risk, 0.71; 95% CI, 0.58-0.86; p = 0.0006), and general complications (relative risk, 0.68; 95% CI, 0.56-0.82; p < 0.0001). No significant differences were found for readmission rates, surgical complications, and mortality.
  
  
  CONCLUSIONS
  This study was limited by the risk of bias in most included studies.
  
  
  CONCLUSIONS
  Enhanced recovery after surgery programs are safe and effective, and increased implementation is justified for perioperative care in colorectal surgery. Future studies may examine the benefits of enhanced recovery after surgery programs in elderly patients and in other GI surgery.
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China.
authors.forename: Cheng-Le
authors.initials: CL
authors.lastname: Zhuang
authors.forename: Xing-Zhao
authors.initials: XZ
authors.lastname: Ye
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Zhang
authors.forename: Bi-Cheng
authors.initials: BC
authors.lastname: Chen
authors.forename: Zhen
authors.initials: Z
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012002:Rectal Diseases / Q000601:surgery*; D055815:Young Adult