Meta-Analysis
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World J Gastroenterol. Nov 7, 2014; 20(41): 15423-15439
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15423
Safety of fast-track rehabilitation after gastrointestinal surgery: Systematic review and meta-analysis
Liu-Hua Wang, Fang Fang, Chun-Ming Lu, Dao-Rong Wang, Ping Li, Ping Fu
Liu-Hua Wang, Department of General Surgery, Yizheng People’s Hospital, Yangzhou 211400, Jiangsu Province, China
Fang Fang, Dao-Rong Wang, Ping Fu, Department of Gastrointestinal Surgery, Subei People’s Hospital of Jiangsu Province, the First Affiliated Hospital of Yang Zhou University, Yangzhou 225001, Jiangsu Province, China
Chun-Ming Lu, Ping Li, Department of General Surgery, Armed Police Corps Hospital of Jiangsu, Yangzhou 225003, Jiangsu Province, China
Author contributions: Wang LH, Fang F and Lu CM contributed equally to this study; Wang LH, Fang F and Lu CM conceived and designed the review, conducted the statistical analyses and contacted authors of included studies to obtain additional information, and drafted the manuscript; Fu P provided supervision; Wang LH, Fang F, Lu CM, Wang DR and Li P identified and acquired reports of trials, analyzed data and assessed risk of bias; all of the authors contributed to the interpretation of data, critically revised the manuscript, and approved the final version of the manuscript submitted for publication and are guarantors for the study.
Supported by The National Natural Science Foundation of China, No. 81172279
Correspondence to: Ping Fu, BM, Department of Gastrointestinal Surgery, Subei People’s Hospital of Jiangsu Province, the First Affiliated Hospital of Yang Zhou University, 98 Nantong West Road, Yangzhou 225001, Jiangsu Province, China. 734909944@qq.com
Telephone: +86-514-87373282 Fax: +86-514-87373282
Received: December 12, 2013
Revised: March 27, 2014
Accepted: July 22, 2014
Published online: November 7, 2014
Processing time: 332 Days and 19.4 Hours
Abstract

AIM: To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery.

METHODS: We searched MEDLINE, WHO International Trial Register, Embase and The Cochrane Central Register of Controlled Trials up to 2014 for randomized controlled trials (RCTs) comparing FT and CC or comparing LFT and OFT, with 10 or more randomized participants and about 30 d follow-up. Two reviewers independently extracted data on complications, anastomotic leak, obstruction, wound infection, re-admission between FT and CC or LFT and OFT after gastrointestinal surgery.

RESULTS: Twenty-four RCTs of FT vs CC or LFT vs OFT were included. Compared with CC, FT reduced overall complications and wound infection. However, anastomotic leak, obstruction and re-admission were not significantly reduced. The pooled risk ratio (RR) of 0.69 (95%CI: 0.60-0.78; P < 0.001), pooled RR of 0.71 (95%CI: 0.57-0.88; P < 0.001), pooled RR of 0.93 (95%CI: 0.68-1.25; P > 0.05), a pooled RR of 0.87 (95%CI: 0.67-1.15; P > 0.05) and pooled RR of 0.94 (95%CI: 0.73-1.22; P > 0.05) respectively. Compared with OFT, LFT reduced complications, with a pooled RR of 0.66 (95%CI: 0.54-0.81; P < 0.001).

CONCLUSION: FTs are safe after gastrointestinal surgery. Additional large, prospective RCTs should be conducted to establish further the safety of this approach.

Keywords: Fast-track rehabilitation protocols; Laparoscopic surgery; Open surgery; Enhanced recovery; Gastrointestinal surgery; Complications; Readmission; Anastomotic leak; Wound infection; Obstruction

Core tip: Fast-track rehabilitation protocols (FT) after gastrointestinal surgery have become the most fashionable method of treatment for gastrointestinal malignancy. Complications after FT for gastrointestinal resection have been discussed in China as well as other countries. This study clarified that compared with conventional care strategies, FT has a low level of complications and similar incidence of re-admission of about 1 mo.