Effectiveness and safety of the enhanced recovery program in colorectal surgery: overview of systematic reviews

  • Kelly Rocío Chacón Acevedo Clinical Epidemiology Master’s Program, Clinical Research Institute, Medical School, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0003-4843-7036
  • Édgar Cortés Reyes Clinical Epidemiology Master’s Program, Clinical Research Institute, Medical School, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0000-0002-3775-846X
  • Óscar Alexander Guevara Cruz Clinical Epidemiology Master’s Program, Clinical Research Institute, Medical School, Universidad Nacional de Colombia. Bogotá, Colombia.
  • Jorge Augusto Díaz Rojas Clinical Epidemiology Master’s Program, Clinical Research Institute, Medical School, Universidad Nacional de Colombia. Bogotá, Colombia.
  • Lina María Rincón Martínez Clinical Epidemiology Master’s Program, Clinical Research Institute, Medical School, Universidad Nacional de Colombia. Bogotá, Colombia.
Keywords: Colorectal surgery, Perioperative care, Enhanced recovery, Systematic reviews, Health technology assessment

Abstract

Introduction: Multimodal enhanced recovery programs are a new paradigm in perioperative care.

Objective: To evaluate the certainty of evidence pertaining to the effectiveness and safety of the multimodal perioperative care program in elective colorectal surgery.

Data source: A search was conducted in the Medline, EMBASE, and Cochrane databases, up until February 2020.

Eligibility criteria: Systematic reviews that take into account the perioperative multimodal program in patients with an indication for colorectal surgery were included. The primary outcomes were morbidity and postoperative deaths. The secondary outcome was hospital length of stay.

Study quality and synthesis method: The reviews were evaluated with AMSTAR-2 and the certainty of the evidence with the GRADE methodology. The findings are presented with measures of frequency, risk estimators, or differences.

Results: Six systematic reviews of clinical trials with medium and high quality in AMSTAR-2 were included. Morbidity was reduced between 16 and 48%. Studies are inconclusive regarding postoperative mortality. Hospital length of stay was reduced by an average of 2.5 days (p <0.05). The certainty of the body of evidence is very low.

Limitations: The effect of the program, depending on the combination of elements, is not clear.

Conclusions and implications: Despite the proven evidence that the program is effective in reducing global postoperative morbidity and hospital stay, the body of evidence is of very low quality. Consequently, results may change with new evidence and further research is required.

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How to Cite
1.
Chacón Acevedo KR, Cortés Reyes Édgar, Guevara Cruz Óscar A, Díaz Rojas JA, Rincón Martínez LM. Effectiveness and safety of the enhanced recovery program in colorectal surgery: overview of systematic reviews. Colomb. j. anesthesiol. [Internet]. 2020Sep.14 [cited 2020Sep.23];49:e943. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/943

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Published
2020-09-14
How to Cite
1.
Chacón Acevedo KR, Cortés Reyes Édgar, Guevara Cruz Óscar A, Díaz Rojas JA, Rincón Martínez LM. Effectiveness and safety of the enhanced recovery program in colorectal surgery: overview of systematic reviews. Colomb. j. anesthesiol. [Internet]. 2020Sep.14 [cited 2020Sep.23];49:e943. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/943
Section
Systematic review