G. Almiron Da R. Soares1, M. Akabane2, T. Pimentel3, D. Souza4, R. Juca5, L. Consoli6, A. Calle Junior7, V. Ivano8, V. Ivano8 1Universidade Metropolitana de Santos, School Of Medicine, Santos, SAO PAULO, Brazil 2Universidade Federal de Juiz de Fora, School Of Medicine, Sao Pedro, JUIZ DE FORA, Brazil 3Universidade Federal de Pernambuco, School Of Medicine, Recife, PERNAMBUCO, Brazil 4TriHealth Good Samaritan Hospital, Cincinnati, OHIO, USA 5Universidade Estadual de Campinas – Unicamp, School Of Medicine, Campinas, SAO PAULO, Brazil 6Universidade Federal da Bahia, School Of Medicine, Salvador, BAHIA, Brazil 7Universidade Federal de Juiz de Fora, School Of Medicine, Sao Pedro, JUIZ DE FORA, Brazil 8Hospital Vivalle, Gastrointestinal Surgery, São José dos Campos, SAO PAULO, Brazil
Introduction: Appendicitis is the primary cause of acute inflammatory abdomen and the most frequent surgical emergency. Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, evidence-based approach that can enhance perioperative outcomes and reduce hospital costs. However, its efficacy in adults undergoing appendectomy remains uncertain, as previous studies in this area are lacking, which calls for further investigation.
Methods: We conducted a meta-analysis by systematically searching MEDLINE, Cochrane Central, Embase, and ClinicalTrials.gov for studies comparing appendectomy patients managed with and without the ERAS protocol. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Statistical analyses were performed with Review Manager v5.4 and RStudio v4.3.3.
Results: Six randomized studies, including 513 patients, were analyzed. Among these, 252 patients (49.1%) underwent appendectomy with the ERAS protocol, and 261 patients (50.8%) without it. The mean age of participants was 31.9 years, and 250 (48.7%) were female. The use of the ERAS protocol was associated with a significant reduction in the length of hospital stay (MD -32.72 hours; 95% CI -45.10 to -20.36; p<0.01), and operation time (MD -2.06 minutes; 95% CI -3.88 to -0.25; p=0.03). No significant differences between the groups were observed in postoperative ileus, readmission rates, time to the first bowel sound, or wound infection.
Conclusion: This meta-analysis suggests that the application of the ERAS protocol in appendectomy patients significantly reduces the length of hospital stay and operation time compared to standard care. Additionally, no significant differences in other postoperative outcomes were found between groups.