The impact of fast track protocols in upper gastrointestinal surgery: A meta-analysis of observational studies |
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Authors: | Charalampos Siotos Konstantinos Stergios Androniki Naska Maximos Frountzas Vasilios Pergialiotis Despina N. Perrea Nikolaos Nikiteas |
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Affiliation: | 1. Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece;2. Department of General Surgery, Watford General Hospital – West Hertfordshire Hospitals NHS Trust, UK;3. Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, Medical School, National and Kapodistrian University of Athens, Athens, Greece |
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Abstract: |
BackgroundFast track surgery has been implemented in colorectal procedures during the last decade and is accompanied by significant improvement in patient outcomes during the early postoperative period. However, to date, its adoption in upper gastrointestinal surgery remains a matter of debate. In this context, we aimed to summarize the existing evidence in the international literature.Materials and methodsWe searched Medline, Scopus, ClinicalTrials.gov and Cochrane Central Register databases for published randomized controlled trials. The meta-analysis was performed with the RevMan 5.3.5 software. Main findingsThirty studies were finally included in the present meta-analysis. The post-operative morbidity was not influenced by the implementation of fast track surgery (FTS) (OR 0.84, 95% CI 0.64–1.09). However, in cases treated with laparoscopic surgery fast track surgery seemed to reduce morbidity by 50% (p = .006). The overall mortality of patients was low in the majority of included studies and was not influenced by fast track surgery (OR 1.12, 95% CI 0.50–2.52). The duration of postoperative hospitalization was significantly reduced with the adoption of FTS (MD ?2.24, 95% CI ?2.63 to ?1.85 days). Concurrently, the overall cost was significantly reduced in cases treated with FTS (MD ?982.30, 95% CI ?1367.68 to ?596.91 U.S dollars).ConclusionAccording to the findings of our meta-analysis suggest that FTS seems to be safe in patients undergoing upper gastrointestinal surgery and reduce both the days of postoperative hospitalization and the overall cost. This observation should be taken into account in future recommendations to enhance the implementation of FTS protocols in current clinical practice. |
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Keywords: | Fast track surgery Upper gastrointestinal ERAS Postoperative morbidity |
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