Enhanced recovery protocols in patients undergoing pancreatic surgery: An umbrella review.
Jing Li, Frances Lin, Shuhui Yu and 1 others
PMID 34105896WHAT IT FOUND
Reviews of enhanced recovery after pancreatic surgery reported shorter hospital stays, lower costs and fewer complications, with no reported increase in mortality or readmission.
All included reviews were critically low quality, so this is not firm evidence.
Key findings
01Ten included systematic reviews reported decreased length of stay, lower hospital costs and decreased total complication rates.
02Hospital stay was reduced by 0.36 to 4.45 days, with no reported difference in mortality, readmission, reoperation or pancreatic fistula.
03All included reviews were rated critically low quality, and only three included randomized controlled trials.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
All included reviews were rated critically low quality. None published their review protocol in advance. None accounted for risk of bias in the primary studies when interpreting results. Only three included reviews contained randomized controlled trials. The ERAS components varied widely, so the bundle being evaluated was not consistent. No review reported discharge standards, and none reported time to first oral intake or mobilization or degree of recovery at discharge.
The easy way to misread this
Do not conclude that enhanced recovery after pancreatic surgery is proven safe and effective, or that any single element such as early mobilization caused shorter stay. The included reviews were critically low quality, and ERAS was evaluated as a multimodal bundle, so individual components cannot be separated.