@article{b1d595db88834e089daecc91254c3dd3,
title = "Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS)",
abstract = "BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have largely been incorporated into practice in high-income settings due to proven improvement in perioperative outcomes. We aimed to review the implementation of ERAS protocols and other perioperative optimisation strategies in low- and middle-income countries (LMICs) and their impact on length of hospital stay (LOS).METHODS: We searched MEDLINE, PubMed, Global Health (CABI), WHO Global Index Medicus, Index Medicus, and Latin American and Caribbean Health Sciences Literature (LILACS) for studies incorporating ERAS or other prehabilitation approaches in LMICs. We conducted a pooled analysis of LOS using a random-effects model to evaluate the impact of such programs. This systematic review was pre-registered on PROSPERO.RESULTS: We screened 1205 studies and included 70 for a full-text review; six were eligible for inclusion and five for quantitative analysis, two of which were randomised controlled trials. ERAS was compared to routine practice in all included studies, while none implemented prehabilitation or other preoperative optimisation strategies. Pooled analysis of 290 patients showed reduced LOS in the ERAS group with a standardised mean difference of -2.18 (95% confidence interval (CI) = -4.13, -.0.05, P < 0.01). The prediction interval was wide (95% CI = -7.85, 3.48) with substantial heterogeneity (I2 = 94%).CONCLUSIONS: Perioperative optimisation is feasible in LMICs and appears to reduce LOS, despite high levels of between-study heterogeneity. There is a need for high-quality data on perioperative practice in LMICs and supplementary qualitative analysis to further understand barriers to perioperative optimisation implementation.REGISTRATION: PROSPERO: CRD42021279053.",
author = "Riad, {Aya M} and Aisling Barry and Knight, {Stephen R} and Arbaugh, {Carlie J} and Haque, {Parvez D} and Weiser, {Thomas G} and Harrison, {Ewen M}",
note = "Funding Information: Acknowledgements: We are grateful to Ruth Jenkins, Academic Support Librarian at the University of Edinburgh, UK for her assistance in developing the search strategies. Funding: No funding was received for this research. Authorship contributions: AMR – generating study question, systematic review registration, search strategy, abstract screening, study selection, data extraction, quality assessment, statistical analysis, manuscript writing, manuscript editing. AB – abstract screening, study selection, data extraction, quality assessment, manuscript writing, manuscript editing. SRK – generating study question, search strategy, abstract screening, study selection, data extraction, quality assessment, statistical analysis, manuscript writing, manuscript editing. CJA - generating study question, search strategy, manuscript writing, manuscript editing. DPH - generating study question, manuscript writing, manuscript editing. TGW - generating study question, systematic review registration, search strategy, abstract screening, study selection, data extraction, quality assessment, statistical analysis, manuscript writing, manuscript editing. EWH - generating study question, systematic review registration, search strategy, abstract screening, study selection, data extraction, quality assessment, statistical analysis, manuscript writing, manuscript editing. Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests. Additional material Online Supplementary Document 1 Adams HA, Hempelmann G. The endocrine stress reaction in anesthesia and surgery–origin and significance. Anasthesiol-ogie, Intensivmedizin, Notfallmedizin, Schmerztherapie. Anasthesiol Intensivmed Notfallmed Schmerzther. 1991;26:294-305. Medline:1751650 doi:10.1055/s-2007-1000588 2 Rosenberg J, Kehlet H. Surgical physiopathology. New results of importance for optimization of the postoperative course. Ugeskr Laeger. 2001;163:908-12. Medline:11228785 3 Nygren J, Hausel J, Kehlet H, Revhaug A, Lassen K, Dejong C, et al. A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery. Clin Nutr. 2005;24:455-61. Medline:15896433 doi:10.1016/j.clnu.2005.02.003 4 Bardram L, Funch-Jensen P, Jensen P, Kehlet H, Crawford M. Recovery after laparoscopic colonic surgery with epidur-al analgesia, and early oral nutrition and mobilisation. Lancet. 1995;345:763-4. Medline:7891489 doi:10.1016/S0140-6736(95)90643-6 5 Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CHC, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466-77. Medline:15896435 doi:10.1016/j.clnu.2005.02.002 Publisher Copyright: {\textcopyright} 2023 The Author(s). All Rights Reserved",
year = "2023",
month = oct,
day = "3",
doi = "10.7189/jogh.13.04114",
language = "English",
volume = "13",
journal = "Journal of Global Health",
issn = "2047-2978",
publisher = "Edinburgh University Global Health Society",
}