Enhancing recovery after minimally invasive surgery in children: A systematic review of the literature and meta-analysis

•Review and evaluate the current evidence available on ERAS after MIS in children, in terms of effectiveness of implementation, and outcome.•The estimated mean difference for the meta-analysis of these studies was −1.12 days (95% CI: −1.5 to −0.82, P < 0.00001), indicating a significant decrease...

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Bibliographic Details
Published in:Journal of pediatric surgery 2021-12, Vol.56 (12), p.2157-2164
Main Authors: Dagorno, Claire, Montalva, Louise, Ali, Liza, Brustia, Raffaele, Paye-Jaquen, Annabel, Pio, Luca, Bonnard, Arnaud
Format: Article
Language:English
Subjects:
Adult
Child
Enhanced Recovery After Surgery
ERAS
Fast-track
Humans
Laparoscopy
Length of Stay
Minimally invasive surgery
Minimally Invasive Surgical Procedures
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Randomized Controlled Trials as Topic
Retroperitoneoscopy
Retrospective Studies
Systematic Reviews as Topic
Thoracoscopy
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Summary:•Review and evaluate the current evidence available on ERAS after MIS in children, in terms of effectiveness of implementation, and outcome.•The estimated mean difference for the meta-analysis of these studies was −1.12 days (95% CI: −1.5 to −0.82, P < 0.00001), indicating a significant decrease in the mean LOS for the ERAS children as compared with the control group.•The intra-operative use of opioids was decreased by ERAS in 4 studies [18–21].•There was no difference in complication rates between ERAS children and control children (OR = 0.84, 95%CI: 0.491.44, p = 0.52).•There was a significant decrease in 30-day readmission rates in ERAS children compared to controls (4% vs 10%, OR = 0.34, 95%CI: 0.180.66, p = 0.001). Enhanced recovery after surgery (ERAS) has been widely implemented after minimally invasive surgeries (MIS) in adults. The aim of this study was to evaluate the current evidence available on ERAS after MIS in children. Using a defined search strategy (PubMed, Cochrane, Scopus), we performed a systematic review of the literature, searching for studies reporting on ERAS after MIS (thoracoscopy, laparoscopy, retroperitoneoscopy) in children (1975–2019). This study was registered with PROSPERO-international prospective register of systematic reviews. A meta-analysis was conducted using comparative studies for length of stay (LOS), complication rates, and readmission rates. Of 180 abstracts screened, 20 full-text articles were analyzed, and 9 were included in our systematic review (1 randomized controlled trial, 3 prospective, and 5 retrospective studies), involving a total number of 531 patients. ERAS has been applied to laparoscopy for digestive (n = 7 studies) or urologic surgeries (n = 1), as well as thoracoscopy (n = 1). Mean LOS was decreased in ERAS children compared to controls (6 studies, −1.12 days, 95%IC: −1.5 to −0.82, p 
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2021.04.004