| 1. |
- Awad, Sherif, et al.
(author)
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A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery
- 2013
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In: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 32:1, s. 34-44
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Research review (peer-reviewed)abstract
- BACKGROUND & AIMS: Whilst preoperative carbohydrate treatment (PCT) results in beneficial physiological effects, the effects on postoperative clinical outcomes remain unclear and were studied in this meta-analysis.METHODS: Prospective studies that randomised adult non-diabetic patients to either PCT (≥50 g oral carbohydrates 2-4 h pre-anaesthesia) or control (fasted/placebo) were included. The primary outcome was length of hospital stay. Secondary outcomes included development of postoperative insulin resistance, complications, nausea and vomiting. Methodological quality was assessed using GRADEpro(®) software.RESULTS: Twenty-one randomised studies of 1685 patients (733 PCT: 952 control) were included. No overall difference in length of stay was noted for analysis of all studies or subgroups of patients undergoing surgery with an expected hospital stay ≤2 days or orthopaedic procedures. However, patients undergoing major abdominal surgery following PCT had reduced length of stay [mean difference, 95% confidence interval: -1.08 (-1.87 to -0.29); I(2) = 60%, p = 0.007]. PCT reduced postoperative insulin resistance with no effects on in-hospital complications over control (risk ratio, 95% confidence interval, 0.88 (0.50-1.53), I(2) = 41%; p = 0.640). There was significant heterogeneity amongst studies and, therefore, quality of evidence was low to moderate.CONCLUSIONS: PCT may be associated with reduced length of stay in patients undergoing major abdominal surgery, however, the included studies were of low to moderate quality.
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| 2. |
- Marimuthu, Kanagaraj, et al.
(author)
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A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery
- 2012
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In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 255:6, s. 1060-1068
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Research review (peer-reviewed)abstract
- Background: Immune modulating nutrition (IMN) has been shown to reduce complications after major surgery, but strong evidence to recommend its routine use is still lacking.Objective: The aim of this meta-analysis was to evaluate the impact of IMN combinations on postoperative infectious and noninfectious complications, length of hospital stay, and mortality in patients undergoing major open gastrointestinal surgery.Methods: Randomized controlled trials published between January 1980 and February 2011 comparing isocaloric and isonitrogenous enteral IMN combinations with standard diet in patients undergoing major open gastrointestinal surgery were included. The quality of evidence and strength of recommendation for each postoperative outcome were assessed using the GRADE approach and the outcome measures were analyzed with RevMan 5.1 software (Cochrane Collaboration, Copenhagen, Denmark).Results: Twenty-six randomized controlled trials enrolling 2496 patients (1252 IMN and 1244 control) were included. The meta-analysis suggests strong evidence in support of decrease in the incidence of postoperative infectious [risk ratio (RR) (95% confidence interval [CI]): 0.64 (0.55, 0.74)] and length of hospital stay [mean difference (95% CI): -1.88 (-2.91, -0.84 days)] in those receiving IMN. Even though significant benefit was observed for noninfectious complications [RR (95% CI): 0.82 (0.71, 0.95)], the quality of evidence was low. There was no statistically significant benefit on mortality [RR (95% CI): 0.83 (0.49, 1.41)].Conclusions: IMN is beneficial in reducing postoperative infectious and noninfectious complications and shortening hospital stay in patients undergoing major open gastrointestinal surgery.
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| 3. |
- Varadhan, Krishna K., et al.
(author)
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Enhanced recovery after surgery : the future of improving surgical care
- 2010
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In: Critical care clinics. - : Elsevier BV. - 0749-0704 .- 1557-8232. ; 26:3, s. 527-547
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Journal article (peer-reviewed)abstract
- Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to attenuate the stress response during the patients' journey through a surgical procedure to facilitate the maintenance of preoperative bodily compositions and organ function and in doing so achieve early recovery. The key factors that keep patients in hospital after uncomplicated major abdominal surgery include the need for parenteral analgesia, intravenous fluids secondary to persistent gut dysfunction, and bed rest caused by lack of mobility. The elements of the ERAS pathways are aimed to address these issues and the interventions that facilitate early recovery cover all three phases of the perioperative period during the patients' journey. They also provide clear guidance to all members of the clinical team.
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| 4. |
- Varadhan, Krishna K, et al.
(author)
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The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery : a meta-analysis of randomized controlled trials
- 2010
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In: Clinical Nutrition. - Edinburgh, United Kingdom : Churchill Livingstone. - 0261-5614 .- 1532-1983. ; 97, s. 35-36
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Journal article (peer-reviewed)abstract
- Background & aims: The aim of the Enhanced Recovery After Surgery (ERAS) pathway is to attenuate the stress response to surgery and enable rapid recovery. The objective of this meta-analysis was to study the differences in outcomes in patients undergoing major elective open colorectal surgery within an ERAS pathway and those treated with conventional perioperative care.Methods: Medline, Embase and Cochrane database searches were performed for relevant studies published between January 1966 and November 2009. All randomized controlled trials comparing ERAS with conventional perioperative care were selected. The outcome measures studied were length of hospital stay, complication rates, readmission rates and mortality.Results: Six randomized controlled trials with 452 patients were included. The number of individual ERAS elements used ranged from 4 to 12, with a mean of 9. The length of hospital stay [weighted mean difference (95% confidence interval): -2.55 (-3.24, -1.85)] and complication rates [relative risk (95% confidence interval): 0.53 (0.44, 0.64)] were significantly reduced in the enhanced recovery group. There was no statistically significant difference in readmission and mortality rates.Conclusion: ERAS pathways appear to reduce the length of stay and complication rates after major elective open colorectal surgery without compromising patient safety.
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