Abstract

INTRODUCTION: Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and metaanalysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. MATERIAL AND METHODS: Searches were conducted using EMBASE, MEDLINE, CINAHL, and the Cochrane Library up to June 27, 2014. Reference lists were screened to identify additional studies. Studies were included if at least four individual items of an enhanced recovery pathway were described. Outcomes included length of hospital stay, complication rates, readmissions, and mortality. Quantitative analysis was limited to comparative studies. Effect sizes were presented as relative risks or as mean differences (MD) with 95% confidence intervals (CI). RESULTS: Thirty-one records, involving 16 observational studies, were included. Diversity in reported elements within studies was observed. Preoperative education, early oral intake, and early mobilization were included in all pathways. Five studies, with a high risk of bias, were eligible for quantitative analysis. Enhanced recovery pathways reduced primary (MD -1.57 days, 95%CI -2.94 to -0.20) and total (MD -3.05 days, 95%CI -4.87 to -1.23) length of hospital stay as compared to traditional perioperative care, without an increase in complication, mortality, and readmission rates. CONCLUSION: The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery. This article is protected by copyright. All rights reserved.
Original languageEnglish
Pages (from-to)382-395
Number of pages14
JournalActa Obstetricia et Gynecologica Scandinavica
Volume95
Issue number4
Early online date21 Dec 2015
DOIs
Publication statusPublished - Apr 2016

Keywords

  • Enhanced recovery
  • enhanced recovery after surgery
  • gynecology
  • perioperative care
  • surgery
  • FAST-TRACK SURGERY
  • COLORECTAL SURGERY
  • POSTOPERATIVE RECOVERY
  • PERIOPERATIVE CARE
  • PANCREATIC SURGERY
  • HYSTERECTOMY
  • PROGRAMS
  • IMPACT
  • QUALITY
  • LENGTH

Cite this

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title = "Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis",
abstract = "INTRODUCTION: Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and metaanalysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. MATERIAL AND METHODS: Searches were conducted using EMBASE, MEDLINE, CINAHL, and the Cochrane Library up to June 27, 2014. Reference lists were screened to identify additional studies. Studies were included if at least four individual items of an enhanced recovery pathway were described. Outcomes included length of hospital stay, complication rates, readmissions, and mortality. Quantitative analysis was limited to comparative studies. Effect sizes were presented as relative risks or as mean differences (MD) with 95{\%} confidence intervals (CI). RESULTS: Thirty-one records, involving 16 observational studies, were included. Diversity in reported elements within studies was observed. Preoperative education, early oral intake, and early mobilization were included in all pathways. Five studies, with a high risk of bias, were eligible for quantitative analysis. Enhanced recovery pathways reduced primary (MD -1.57 days, 95{\%}CI -2.94 to -0.20) and total (MD -3.05 days, 95{\%}CI -4.87 to -1.23) length of hospital stay as compared to traditional perioperative care, without an increase in complication, mortality, and readmission rates. CONCLUSION: The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery. This article is protected by copyright. All rights reserved.",
keywords = "Enhanced recovery, enhanced recovery after surgery, gynecology, perioperative care, surgery, FAST-TRACK SURGERY, COLORECTAL SURGERY, POSTOPERATIVE RECOVERY, PERIOPERATIVE CARE, PANCREATIC SURGERY, HYSTERECTOMY, PROGRAMS, IMPACT, QUALITY, LENGTH",
author = "{de Groot}, Jeanny and Stephanie Ament and Maessen, {Jos{\'e} M. C.} and Dejong, {Cornelis H.C.} and Kleijnen, {Jos M.P.} and Slangen, {Brigitte F.M.}",
year = "2016",
month = "4",
doi = "10.1111/aogs.12831",
language = "English",
volume = "95",
pages = "382--395",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
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Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis. / de Groot, Jeanny; Ament, Stephanie; Maessen, José M. C.; Dejong, Cornelis H.C.; Kleijnen, Jos M.P.; Slangen, Brigitte F.M.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 95, No. 4, 04.2016, p. 382-395.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis

AU - de Groot, Jeanny

AU - Ament, Stephanie

AU - Maessen, José M. C.

AU - Dejong, Cornelis H.C.

AU - Kleijnen, Jos M.P.

AU - Slangen, Brigitte F.M.

PY - 2016/4

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N2 - INTRODUCTION: Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and metaanalysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. MATERIAL AND METHODS: Searches were conducted using EMBASE, MEDLINE, CINAHL, and the Cochrane Library up to June 27, 2014. Reference lists were screened to identify additional studies. Studies were included if at least four individual items of an enhanced recovery pathway were described. Outcomes included length of hospital stay, complication rates, readmissions, and mortality. Quantitative analysis was limited to comparative studies. Effect sizes were presented as relative risks or as mean differences (MD) with 95% confidence intervals (CI). RESULTS: Thirty-one records, involving 16 observational studies, were included. Diversity in reported elements within studies was observed. Preoperative education, early oral intake, and early mobilization were included in all pathways. Five studies, with a high risk of bias, were eligible for quantitative analysis. Enhanced recovery pathways reduced primary (MD -1.57 days, 95%CI -2.94 to -0.20) and total (MD -3.05 days, 95%CI -4.87 to -1.23) length of hospital stay as compared to traditional perioperative care, without an increase in complication, mortality, and readmission rates. CONCLUSION: The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery. This article is protected by copyright. All rights reserved.

AB - INTRODUCTION: Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and metaanalysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. MATERIAL AND METHODS: Searches were conducted using EMBASE, MEDLINE, CINAHL, and the Cochrane Library up to June 27, 2014. Reference lists were screened to identify additional studies. Studies were included if at least four individual items of an enhanced recovery pathway were described. Outcomes included length of hospital stay, complication rates, readmissions, and mortality. Quantitative analysis was limited to comparative studies. Effect sizes were presented as relative risks or as mean differences (MD) with 95% confidence intervals (CI). RESULTS: Thirty-one records, involving 16 observational studies, were included. Diversity in reported elements within studies was observed. Preoperative education, early oral intake, and early mobilization were included in all pathways. Five studies, with a high risk of bias, were eligible for quantitative analysis. Enhanced recovery pathways reduced primary (MD -1.57 days, 95%CI -2.94 to -0.20) and total (MD -3.05 days, 95%CI -4.87 to -1.23) length of hospital stay as compared to traditional perioperative care, without an increase in complication, mortality, and readmission rates. CONCLUSION: The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery. This article is protected by copyright. All rights reserved.

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KW - enhanced recovery after surgery

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KW - surgery

KW - FAST-TRACK SURGERY

KW - COLORECTAL SURGERY

KW - POSTOPERATIVE RECOVERY

KW - PERIOPERATIVE CARE

KW - PANCREATIC SURGERY

KW - HYSTERECTOMY

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KW - IMPACT

KW - QUALITY

KW - LENGTH

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JO - Acta Obstetricia et Gynecologica Scandinavica

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SN - 0001-6349

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