Table_1_Enhanced Recovery Care vs. Traditional Care in Laparoscopic Hepatectomy: A Systematic Review and Meta-Analysis.DOCX

BackgroundEnhanced recovery care could alleviate surgical stress and accelerate the recovery rates of patients. Previous studies showed the benefits of enhanced recovery after surgery program in liver surgery, but the exact role in laparoscopic hepatectomy is still unclear.AimWe aimed to perform a meta-analysis to evaluate the safety and efficacy of enhanced recovery after a surgery program in laparoscopic hepatectomy.MethodsThe relative studies from a specific search of PUBMED, EMBASE, OVID, and Cochrane database from June 2008 to February 2022 were selected and included in this meta-analysis. The primary outcomes included length of hospital stay, duration to functional recovery, and overall postoperative complication rate. The secondary outcomes included operative time, intraoperative blood loss, cost of hospitalization, readmission rate, Grade I complication rate, and Grade II–V complication rate.ResultsA total of six studies with 643 patients [enhanced recovery care (n = 274) vs. traditional care (n = 369)] were eligible for analysis. These comprised three randomized controlled trials and three retrospective studies. Enhanced recovery care group was associated with decreased hospital stay [standard mean difference (SMD) = −0.56, 95% confidence interval (CI) = −0.83~−0.28, p < 0.0001], shorter duration to functional recovery (SMD = −1.14, 95% CI = −1.92~−0.37, p = 0.004), and lower cost of hospitalization Mean Difference (MD) = −1,539.62, 95% CI = −1992.85~−1086.39, p < 0.00001). Moreover, a lower overall postoperative complication rate was observed in enhanced recovery care group [Risk ratio (RR) = 0.64, 95% CI = 0.51~0.80, p < 0.0001] as well as lower Grade II–V complication rate (RR = 0.55, 95% CI = 0.38~0.80, p = 0.002), while there was no significant difference in intraoperative blood loss (MD = −65.75, 95% CI = −158.47~26.97, p = 0.16), operative time (MD = −5.44, 95% CI = −43.46~32.58, p = 0.78), intraoperative blood transfusion rate [Odds ratio (OR) = 0.71, 95% CI = 0.41~1.22, p = 0.22], and Grade I complication rate (RR = 0.73, 95% CI = 0.53~1.03, p = 0.07).ConclusionEnhanced recovery care in laparoscopic hepatectomy should be recommended, because it is not only safe and effective, but also can accelerate the postoperative recovery and lighten the financial burden of patients.

背景：强化康复护理能够缓解手术应激并加速患者的康复进程。既往研究表明，强化康复护理方案在肝切除术中的益处，但其对腹腔镜肝切除术的具体作用尚不明确。目标：本研究旨在通过元分析评估强化康复护理方案在腹腔镜肝切除术中的安全性和有效性。方法：从2008年6月至2022年2月期间的PUBMED、EMBASE、OVID和Cochrane数据库中，选取相关研究并纳入此次元分析。主要结局指标包括住院时间、功能恢复所需时间和总体术后并发症发生率。次要结局指标包括手术时间、术中出血量、住院费用、再次入院率、I级并发症发生率和II至V级并发症发生率。结果：共有6项研究（强化康复护理组n=274，传统护理组n=369）符合分析条件，包括3项随机对照试验和3项回顾性研究。强化康复护理组与缩短住院时间[标准化均数差（SMD）= −0.56，95%置信区间（CI）= −0.83~−0.28，p < 0.0001]、缩短功能恢复所需时间（SMD = −1.14，95% CI = −1.92~−0.37，p = 0.004）和降低住院费用[平均差异（MD）= −1,539.62，95% CI = −1992.85~−1086.39，p < 0.00001]相关。此外，强化康复护理组观察到较低的总体术后并发症发生率[风险比（RR）= 0.64，95% CI = 0.51~0.80，p < 0.0001]以及较低的II至V级并发症发生率（RR = 0.55，95% CI = 0.38~0.80，p = 0.002），而术中出血量[平均差异（MD）= −65.75，95% CI = −158.47~26.97，p = 0.16]、手术时间[平均差异（MD）= −5.44，95% CI = −43.46~32.58，p = 0.78]、术中输血率[优势比（OR）= 0.71，95% CI = 0.41~1.22，p = 0.22]和I级并发症发生率[风险比（RR）= 0.73，95% CI = 0.53~1.03，p = 0.07]方面则无显著差异。结论：鉴于强化康复护理在腹腔镜肝切除术中的安全性、有效性和加速术后康复、减轻患者经济负担的优势，应推荐其在临床中应用。