title: Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: A meta-analysis.
abstract: OBJECTIVE
  Enhanced recovery after surgery (ERAS) programs are a series of measures being taken during the perioperation to alleviate surgical stress and accelerate the recovery rate of patients. Although several studies reported the efficacy of ERAS in liver surgery, the role of ERAS in laparoscopic hepatectomy is still unclear. This meta-analysis is aimed to evaluate the efficacy and safety of ERAS programs versus traditional care in laparoscopic hepatectomy.
  
  
  METHODS
  We searched PubMed, EMBASE, the Cochrane Library, CNKI, Wang Fang Database and VIP Database for randomized controlled trials (RCTs) or clinical controlled trials (CCTs) concerning using ERAS in laparoscopic hepatectomy. Data collection ended in June 1st, 2016. The main end points were intraoperative blood loss, intraoperative blood transfusion, operative time, the cost of hospitalization, time to first flatus, the time to first diet after surgery, duration of postoperative hospital stay, total postoperative complication rate, gradeⅠcomplication rate, grade Ⅱ-Ⅴcomplication rate.
  
  
  RESULTS
  8 studies with 580 patients were eligible for analysis. There were 292 cases in ERAS group and 288 cases in traditional perioperative care (CTL) group. Compared with CTL group, ERAS group was associated with significantly accelerated of time to first diet after surgery (SMD = -1.79, 95%CI: -3.19 ∼ -0.38, P = 0.01), time to first flatus (MD = -0.51, 95%CI: -0.91 ∼ -0.12, P = 0.01). Meanwhile, it was associated with significantly decreased of duration of the postoperative hospital stay (MD = -3.31, 95%CI: -3.95 ∼ -2.67, P < 0.00001), cost of hospitalization (MD = -1.0, 95%CI: -1.49 ∼ -0.51, P < 0.0001), total postoperative complication rate (OR = 0.34, 95%CI: 0.15-0.75, P = 0.008), gradeⅠcomplication rate (OR = 0.37, 95%CI: 0.22-0.64, P = 0.0003) and gradeⅡ-Ⅴcomplication rate (OR = 0.49, 95%CI: 0.32-0.77, P = 0.002). Whereas there was no significantly difference in intraoperative blood loss (P > 0.05), intraoperative blood transfusion (P > 0.05), operative time (P > 0.05) between ERAS group and CTL group.
  
  
  CONCLUSIONS
  Application of ERAS in laparoscopic hepatectomy is safe and effective, and it could accelerate the postoperative recovery and lighten the financial burden of patients.
authors.affiliation: Department of Hepatobiliary & Pancreatic Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China. Electronic address: 549869043@qq.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Yang
authors.affiliation: Department of Pediatric, Renmin Hospital of Wuhan University, Wuhan, 430060, China. Electronic address: taowan1992@163.com.
authors.forename: Wan
authors.initials: W
authors.lastname: Tao
authors.affiliation: Department of Pain, Puai Hospital, Wuhan, 430000, China. Electronic address: 896817639@qq.com.
authors.forename: Yang-Yang
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Department of Pediatric, Renmin Hospital of Wuhan University, Wuhan, 430060, China. Electronic address: 502028401@qq.com.
authors.forename: Bing-Hong
authors.initials: BH
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary & Pancreatic Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China. Electronic address: 65343502@qq.com.
authors.forename: Jun-Ming
authors.initials: JM
authors.lastname: Tang
authors.affiliation: Department of Hepatobiliary & Pancreatic Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China. Electronic address: zhongsenys@163.com.
authors.forename: Sen
authors.initials: S
authors.lastname: Zhong
authors.affiliation: Department of Hepatobiliary & Pancreatic Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China. Electronic address: 2272534937@qq.com.
authors.forename: Xian-Xiang
authors.initials: XX
authors.lastname: Chen
mesh_terms: D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function
keywords: Enhanced recovery after surgery; Hepatectomy; Laparoscopy; Meta-analysis