Systematic Reviews
Copyright ©The Author(s) 2021.
World J Clin Cases. May 6, 2021; 9(13): 3024-3037
Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.3024
Table 1 Summary of studies included in the analysis along with details of the clinical pathway, compliance and comparison between groups
Ref.
Study design
n
Age (yr)
Number of clinical pathway factors
Overall compliance (%)
Comparison groups (% of compliance)
NOS
Braga et al[16], 2014Prospective11569 (61-74)12 (4 Pre- + 3 Intra- + 5 Post-op)NANo group stratification-
Zouros et al[17], 20161Prospective7565.9 ± 10.55 (Post-op)NA100% (n = 53) vs < 100% (n = 22)7
Kagedan et al[18], 20171Retrospective8265 (56-74)4 (Post-op)NA100% (n = 134) vs < 100% (n = 134)6
Tremblay St-Germain et al[20], 2017Retrospective8365 (29-85)8 (Post-op)NANo group stratification-
Agarwal et al[23], 2018Prospective39455 (18-81)13 (6 Pre + 4 Intra- + 3 Post-op)84≥ 80% (n = 278) vs < 80% (n = 116)-
Williamsson et al[24], 20191Retrospective16066-698 (Post-op)52≥ 50% (n = 134) vs < 50% (n = 26)7
Karunakaran et al[6], 20201Retrospective16259 (19-84)8 (Post-op)53≥ 50% (n = 98) vs < 50% (n = 64)7
Roulin et al[10], 2020Prospective39065.3 ± 11.619 (7 Pre + 3 Intra- + 9 Post-op)62 (30 for post-operative components)≥ 70% (n = 85) vs < 70% (n = 305)-
Tankel et al[21], 2020Prospective9768 (17-85)7 (Post-op)NANo group stratification-
Capretti et al[22], 20201Prospective20564.7 ± 13.716 (5 Pre + 5 Intra- + 6 Post-op)68.4100% (n = 52) vs < 100% (n = 152)7
St-Amour et al[19], 2020Retrospective8968 (61-73)NA63 (36 for post-op)≥ 67% vs < 67%-
Table 2 Summarising the morbidity, mortality and readmission rates along with length of stay and impact of deviations on these outcomes
Ref.Length of stay1 (d)Complications (%)
Mortality (%)Readmissions (%)Impact of deviations/non-compliance to clinical pathway


Overall
≥ CD 3



Braga et al[16]14.6 ± 9.860203.512.2Significantly lower deviations in patients with uneventful post-operative course; Lower compliance correlated with severity of postoperative complications; Low compliance to early oral feeding most likely to be associated with postoperative complications
Zouros et al[17]9.7 ± 5.634.714.746.7< 100% compliance associated with significantly higher rates of postoperative complications (72.7% vs 20.8%; P < 0.001)
Kagedan et al[18]9 (7-14)NANA0.816< 100% compliance associated with longer length of stay (13 vs 7 d, P < 0.001) and greater mean total cost of the index postoperative hospitalization ($20392.81 CAD vs $10562.28 CAD, P < 0.002)
Tremblay St-Germain et al[20]8 (4-35)67.5290222Failure to remove urinary catheter by POD 3, and initiate solid diet ≤ POD 4 (P < 0.01 and P < 0.001, respectively), more likely to have prolonged length of stay (> 8 d)
Agarwal et al[23]12 (4-78)63.233.23.5 7.8 < 80% compliance associated with significantly increased major complications (44% vs 28.7%, P < 0.004), CR-POPF (32.7% vs 20.8%, P < 0.012), longer length of stay [15 (4-61) vs 11 (5-78), P < 0.001)], re-explorations (17.2% vs 6.8%, P < 0.002), escalation of antibiotics (24.1% vs 14.7%, P < 0.025) and mortality (6.8% vs 2.1%, P = 0.021)
Williamsson et al[24]12 (6-97)69.421.25 1.2516.252< 50% compliance associated with delayed discharge [10 (6-77) vs 23 (8-97) d] and higher incidence of CD ≥ 3A complications [21 (16%) vs 13 (50%)]; ≥ 90% (n = 13) compliance had a median discharge of POD 8 (7-9) and no complication ≥ CD3A
Karunakaran et al[6]10.8 ± 5.87123.56.223.72< 50% compliance significantly higher risk of complications [DGE (79.7% vs 19.4%, P = 0.0001); POPF (22.2% vs 8.1%, P < 0.025); CD 3/4 complications (37.5% vs 6.1%, P < 0.0001)], longer length of stay (14 vs 10.8 d, P < 0.0001), 90-d readmissions (40.7% vs 14.3%, P = 0.0001) and mortality (14.1% vs 1%, P < 0.003)
Roulin et al[10]14 (9-22)83.736.93.111.3< 70% compliance significantly increased length of stay [15 (10-23) vs 11 (7-16) d, P < 0.001], and overall (88.9% vs 78.8%, P < 0.029) and major (43.6 vs 28.2, P < 0.012) complications (especially respiratory and infectious)
Tankel et al[21]14 (6-100)NA21.62.128.9< 100% compliance had a longer length of stay ≥ 14 d
Capretti et al[22]14.1 ± 8.654.615.613.4Sum of failed ERP components/deviations significantly correlated with postoperative complications
St-Amour et al[19]NANANANANANo significant effect of ERAS® compliance on time to receipt of adjuvant chemotherapy from surgery, or disease-free survival