Enhanced recovery after surgery (ERAS) vs standard care in peptic ulcer perforation: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared enhanced recovery after surgery (ERAS) with standard postoperative care after open or laparoscopic Graham repair for peptic ulcer perforation. Twelve studies involving 963 patients were included. ERAS was associated with shorter hospitalisation and lower rates of several complications, including venous thromboembolism (0.25; 95% CI, 0.14-0.47; P <.0001) and superficial surgical site infection (0.47; 95% CI, 0.34-0.66; P <.0001). The findings support an association between ERAS and reduced morbidity, but the abstract does not establish that ERAS caused these differences.

Key findings

• Across 12 studies and 963 patients, ERAS was associated with significantly shorter hospitalisation (0.65; 95% CI, 0.49-0.87; P =.003).
• Venous thromboembolism was lower with ERAS than standard care (0.25; 95% CI, 0.14-0.47; P <.0001).
• Superficial and deep surgical site infections were lower with ERAS (0.47; 95% CI, 0.34-0.66; P <.0001 and 0.36; 95% CI, 0.17-0.77; P =.008, respectively).
• The review reports lower pulmonary complication rates with ERAS, but provides no quantitative estimate in the abstract.

Why it matters

Peptic ulcer perforation requires prompt intervention, and postoperative recovery can involve substantial morbidity. This synthesis suggests that ERAS pathways may be associated with shorter stays and fewer perioperative complications than conventional care in this setting. These findings can inform evaluation of postoperative pathways, while the evidence should be interpreted in light of the included studies’ designs and the absence of causal certainty in the abstract.

What to keep in mind

The review combines 12 studies, but the abstract does not specify their designs or provide details on heterogeneity; the pooled findings therefore cannot be assumed to establish causation.