Safety of fast-track rehabilitation after gastrointestinal surgery: systematic review and meta-analysis.
OBJECTIVE
To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery.


METHODS
We searched MEDLINE, WHO International Trial Register, Embase and The Cochrane Central Register of Controlled Trials up to 2014 for randomized controlled trials (RCTs) comparing FT and CC or comparing LFT and OFT, with 10 or more randomized participants and about 30 d follow-up. Two reviewers independently extracted data on complications, anastomotic leak, obstruction, wound infection, re-admission between FT and CC or LFT and OFT after gastrointestinal surgery.


RESULTS
Twenty-four RCTs of FT vs CC or LFT vs OFT were included. Compared with CC, FT reduced overall complications and wound infection. However, anastomotic leak, obstruction and re-admission were not significantly reduced. The pooled risk ratio (RR) of 0.69 (95%CI: 0.60-0.78; P < 0.001), pooled RR of 0.71 (95%CI: 0.57-0.88; P < 0.001), pooled RR of 0.93 (95%CI: 0.68-1.25; P > 0.05), a pooled RR of 0.87 (95%CI: 0.67-1.15; P > 0.05) and pooled RR of 0.94 (95%CI: 0.73-1.22; P > 0.05) respectively. Compared with OFT, LFT reduced complications, with a pooled RR of 0.66 (95%CI: 0.54-0.81; P < 0.001).


CONCLUSIONS
FTs are safe after gastrointestinal surgery. Additional large, prospective RCTs should be conducted to establish further the safety of this approach.
Liu-Hua Wang, Department of General Surgery, Yizheng People's Hospital, Yangzhou 211400, Jiangsu Province, China.
Liu-Hua
LH
Wang
Liu-Hua Wang, Department of General Surgery, Yizheng People's Hospital, Yangzhou 211400, Jiangsu Province, China.
Fang
F
Fang
Liu-Hua Wang, Department of General Surgery, Yizheng People's Hospital, Yangzhou 211400, Jiangsu Province, China.
Chun-Ming
CM
Lu
Liu-Hua Wang, Department of General Surgery, Yizheng People's Hospital, Yangzhou 211400, Jiangsu Province, China.
Dao-Rong
DR
Wang
Liu-Hua Wang, Department of General Surgery, Yizheng People's Hospital, Yangzhou 211400, Jiangsu Province, China.
Ping
P
Li
Liu-Hua Wang, Department of General Surgery, Yizheng People's Hospital, Yangzhou 211400, Jiangsu Province, China.
Ping
P
Fu
D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000534:rehabilitation*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000534:rehabilitation*; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Anastomotic leak; Complications; Enhanced recovery; Fast-track rehabilitation protocols; Gastrointestinal surgery; Laparoscopic surgery; Obstruction; Open surgery; Readmission; Wound infection