Safety of fast-track rehabilitation after gastrointestinal surgery: Systematic review and meta-analysis

Table 1 Main characteristics of the 24 included studies

Ref.	Way	Year	No.		Age (yr)		Sex (M:F)
			FT	CC	FT	CC	FT	CC
Ionescu et al[25]	Open	2009	48	48	60.94 ± 9.9	63.1 ± 12.19	30:18	31:17
Ren et al[26]	Open	2012	299	298	59	61	178:121	190:108
Yang et al[27]	Open	2012	32	30	57.2 ± 11.70	59.5 ± 12.10	20:12	22:8
Hübner et al[28]	Open	2010	36	31	60	61	18:18	17:14
Wang et al[29]	Open	2012	41	42	57.2 ± 18.1	55.4 ± 16.8	24:17	25:17
Vlug et al[30]	Open	2011	93	98	66 ± 10.3	66 ± 7.1	54:39	59:39
van Bree et al[31]	Lap	2011	18	18	64 ± 10.1	66 ± 6.9	11:7	11:7
Veenhof et al[32]	Lap	2012	17	20	65	68	9:8	14:6
Serclová et al[33]	Lap/open	2009	51	52	35.1 ± 11.0	37.6 ± 12.5	20:31	32:20
Muller et al[34]	Lap/open	2009	76	75	62	59	37:39	40:35
Wang et al[35]	Lap/open	2011	40	38	71	72	22:18	20:18
Wang et al[36]	Lap/open	2011	106	104	57	55	65:41	60:44
King et al[38]	Lap/open	2008	41	19	72.3	70.4	23:18	8:11
Faiz et al[37]	Lap/open	2008	191	50	67.9 ± 14.1	66.3 ± 13.7	20:30	98:93
Srinivasa et al[39]	Lap/open	2013	37	37	69 ± 16	72 ± 12	19:18	22:15
Basse et al[40]	Lap/open	2005	30	30	75.5	75	14:16	14:16
MacKay et al[41]	Lap/open	2006	22	58	72	73.2	12:10	25:33
García-Botello et al[42]	Lap/open	2011	61	58	62	60	40:21	32:26
Anderson et al[43]	Open	2003	14	11	64	68	6:86	5:6
Gatt et al[44]	Open	2005	19	20	67	67	14:6	9:109
Khooet al[2]	Open	2007	35	35	69.3	73	12:23	15:20
Wang et al[45]	Open	2010	47	45	58.76 ± 9.66	56.87 ± 9.16	32:133	29:18
Chen Hu et al[46]	Lap/open	2012	40	42	59/64	62.5/64.5	19:21	22:20
Lemanu et al[47]	Lap	2012	40	38	43.5	43.9	13:27	10:28

Lap: Laparoscopy.

Table 2 Risk-of-bias assessment of the randomized controlled trials

Ref.	Selection bias	Performance bias	Detection bias	Attrition bias	Reporting	Overall risk of bias
Ionescu et al[25]	Low	Low	Low	Low	Low	Low
Ren et et al[26]	Low	Unclear	Low	Low	Low	Low
Yang et al[27]	Low	Low	Low	Unclear	Low	Low
Hübner et al[28]	Low	Low	Low	Low	Low	Low
Wang et al[29]	Low	Low	Low	Low	Unclear	Low
Vlug et al[30]	Unclear	Low	Low	Low	Low	Low
van et al[31]	Low	Low	Low	Low	Unclear	Low
Veenhof et al[32]	Low	Low	Unclear	Low	Low	Low
Serclová et al[33]	Low	Low	Low	Low	Unclear	Low
Muller et al[34]	Low	Low	Low	Low	Unclear	Low
Wang et al[35]	Unclear	Low	Low	Low	Low	Low
Wang et al[36]	Unclear	Low	Low	Low	Low	Low
King et al[38]	Low	Low	Unclear	Low	Low	Low
Faiz et al[37]	Low	Low	Low	Low	Unclear	Low
Srinivasa et al[39]	Low	Unclear	Low	Low	Low	Low
Basse et al[40]	Unclear	Low	Low	Low	Low	Low
MacKay et al[41]	Low	Low	Low	Low	Low	Low
García-Botello et al[42]	Low	Low	Low	Low	Unclear	Low
Anderson et al[43]	Low	Low	Low	Low	Low	Low
Gatt et al[44]	Low	Unclear	Low	Low	Low	Low
Khoo et al[2]	Low	Low	Low	Low	Low	Low
Wang et al[45]	Low	Low	Low	Low	Low	Low
Chen Hu et al[46]	Low	Low	Low	Low	Low	Low
Lemanu et al[47]	Low	Low	Low	Low	Unclear	Low

Selection bias is based on random sequence generation and allocation concealment; performance bias includes blinding of participants and study investigators for the outcomes of interest; detection bias includes blinding of outcome assessors; attrition bias indicates systematic loss of participants in one arm, which could lead to missing outcome data for that trial arm over the other trial arm; and reporting bias includes the possibility of selective outcome reporting. Selection bias is a feature of the trial design. Performance and detection bias are overall low given that most data were collected without any prior knowledge of the investigators of the tested hypothesis in this study at the time of event collection. All analyses in this report are based on intention-to-treat and we further mitigated the possible effect of any attrition bias and reporting bias at individual trial level by collection of additional unpublished data.

Table 3 Risk ratio and 95%CI of complications for FT vs CC during colorectal surgery in all of the patients

Outcome or subgroup	Studies(n)	Participants(n)	Effect estimateRR (95%CI)	heterogeneity
				I2	P value
1.1 Complication
1.1.1 FT vs CC	19	2538	0.67 (0.56, 0.82)	58%	0.0009
1.1.2 OFT vs OCC	15	1690	0.73 (0.58, 0.93)	57%	0.003
1.1.3 LFT vs LCC	8	774	0.58 (0.38, 0.88)	62%	0.01
1.1.4 LFT vs OFT	8	586	0.72 (0.56, 0.92)	24%	0.24
1.2 Anastomotic leak
1.2.1 FT vs CC	11	1939	0.92 (0.60, 1.43)	0%	0.96
1.2.2 OFT vs OCC	9	1364	0.90 (0.53, 1.53)	0%	0.90
1.2.3 LFT vs LCC	5	575	0.98 (0.48, 2.01)	0%	0.60
1.2.4 LFT vs OFT	6	626	0.83 (0.40, 1.73)	0%	0.78
1.3 obstruction
1.3.1 FT vs CC	9	1698	0.87 (0.59, 1.29)	0%	0.96
1.3.2 OFT vs OCC	7	1160	0.97 (0.62, 1.52)	0%	1.00
1.3.3 LFT vs LCC	4	539	0.67 (0.32, 1.42)	0%	0.62
1.3.4 LFT vs OFT	3	295	1.23 (0.51, 3.00)	0%	0.40
1.4 Wound infection
1.4.1 FT vs CC	14	2133	0.72 (0.52, 0.97)	10%	0.34
1.4.2 OFT vs OCC	12	1461	0.72 (0.51, 1.02)	28%	0.18
1.4.3 LFT vs LCC	5	539	0.64 (0.32, 1.26)	0%	0.91
1.4.4 LFT vs OFT	4	329	0.51 (0.26, 1.01)	35%	0.20
1.5 re-admission
1.5.1 FT vs CC	11	1468	0.99 (0.71, 1.39)	0%	0.80
1.5.2 OFT vs OCC	8	781	1.07 (0.60, 1.91)	0%	0.85
1.5.3 LFT vs LCC	5	613	0.74 (0.43, 1.28)	0%	0.82
1.5.4 LFT vs OFT	6	671	0.45 (0.29, 0.71)	14%	0.32