title: Fast-track programs versus traditional care in hepatectomy: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The role of fast-track programs in hepatectomy is unclear. This meta-analysis aimed to evaluate the efficacy and safety of fast-track programs versus traditional care.
  
  
  METHODS
  We searched Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar for relevant randomized controlled trials (RCTs) comparing fast-track with traditional care in hepatectomy. Length of hospital stay, time to first flatus, postoperative complications, operating time, and intraoperative blood loss were assessed. Meta-analyses were performed using RevMan 5.2 software.
  
  
  RESULTS
  Four original RCTs with 372 patients were included: 187 in the fast-track and 185 in the traditional care group. Fast-track patients had shorter hospital stay (WMD -2.32; 95% CI, -3.54 to -1.11; p < 0.001) and time to first flatus (WMD -0.99; 95% CI, -1.15 to -0.84; p < 0.001), and less postoperative complications (RR 0.66; 95% CI, 0.47 to 0.93; p < 0.05). However, there was significant heterogeneity between the studies regarding hospital stay (I(2) = 88%; p < 0.001). Operating time and intraoperative blood loss were not different.
  
  
  CONCLUSIONS
  Patients in fast-track programs had less time to first flatus and postoperative complications compared to traditional care. Fast-track programs may reduce the length of hospital stay. Larger, higher quality prospective RCTs are necessary to draw more robust conclusions.
authors.affiliation: Department of General Surgery, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Qiucheng
authors.initials: Q
authors.lastname: Lei
authors.forename: Xinying
authors.initials: X
authors.lastname: Wang
authors.forename: Shanjun
authors.initials: S
authors.lastname: Tan
authors.forename: Xianfeng
authors.initials: X
authors.lastname: Xia
authors.forename: Huazhen
authors.initials: H
authors.lastname: Zheng
authors.forename: Chao
authors.initials: C
authors.lastname: Wu
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D002681:China; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome