Effect of enhanced recovery after surgery protocols on mortality and morbidity after trauma and non-trauma emergency laparotomies: a systematic review and meta-analysis.

To evaluate the effect of Enhanced Recovery After Surgery (ERAS) protocols on mortality and morbidity after trauma and non-trauma emergency laparotomies. A PRISMA-compliant meta-analysis using random-effects modelling was conducted. All studies comparing outcomes of ERAS with no ERAS in adult patients undergoing emergency laparotomies in either trauma or non-trauma settings were included. Thirty-day mortality and morbidity were the outcomes. Trauma and non-trauma patients were analysed separately. Nine studies comprising 707 patients were included (ERAS group: 336; no ERAS group: 371). The ERAS components were preoperative counselling in 67% of studies, intraoperative hypothermia prevention in 67%, intraoperative goal-based fluid therapy in 55%, early oral intake in 100%, multimodal analgesia in 100%, early mobilisation in 100%, and early removal of tubes in 100%. The baseline characteristics of ERAS and no ERAS groups were comparable. In trauma setting, ERAS protocols did not improve the risk of postoperative mortality (0% vs 0%, RD: 0.00, 95% CI − 0.02 to 0.02, p = 0.999) or morbidity (30.0% vs 36.0%, OR: 0.67, 95% CI 0.38–1.17, p = 0.160). In non-trauma setting, ERAS protocols did not improve the risk of mortality (3.4% vs 4.6%, RD: − 0.00, 95% CI − 0.03 to 0.02, p = 0.810) but they reduced the risk of morbidity (62.7% vs 96.0%, OR: 0.06, 95% CI 0.02–0.15, p < 0.0001). ERAS protocols are feasible and safe in patients undergoing trauma and non-trauma emergency laparotomies. They do not seem to improve morbidity and mortality after trauma laparotomies (moderate certainty). Although they reduce morbidity after non-trauma emergency laparotomies, the mortality risk remains unaffected (high certainty).