EFFICACY OF THE ERAS (ENHANCED RECOVERY AFTER SURGERY) PROTOCOL IN THE POSTOPERATIVE RECOVERY OF ABDOMINAL SURGERIES: A SYSTEMATIC REVIEW

Abstract

Introduction: Postoperative recovery is a significant challenge in abdominal surgeries due to the complications associated with surgical trauma. The Enhanced Recovery After Surgery (ERAS) protocol was developed as a multimodal approach to optimize perioperative management, reduce complications, and accelerate hospital discharge. However, the variability of results between different types of surgery and patient populations suggests the need for a systematic review to consolidate the available evidence. Methodology: This systematic review followed the PRISMA guidelines for article selection, using the acronym PICO to formulate the research question: "Is the ERAS protocol effective in postoperative recovery of patients undergoing abdominal surgery compared to conventional care?". The search was carried out in databases such as PubMed, Cochrane and SciELO, including randomized controlled trials and cohort studies published in the last ten years. The methodological quality of the articles was analyzed based on established criteria, and the agreement between reviewers was evaluated by the Kappa index. Results: The studies analyzed demonstrated that the application of the ERAS protocol is associated with a significant reduction in the length of hospital stay, ranging from 2.5 to 3.5 days compared to the control group. In gastrointestinal surgeries, the complication rate was 15% in the ERAS group versus 30% in the control group. In procedures such as hepatectomy, the adoption of the protocol resulted in a decrease in postoperative complications and a reduced length of hospital stay (p < 0.001). However, some surgeries, such as hysterectomies and pancreaticoduodenectomy, did not show significant differences between the groups. The rate of hospital readmission presented conflicting findings, being reduced in some studies, but without statistical difference in others. Discussion: The findings confirm that the ERAS protocol has a positive impact on reducing postoperative complications, length of hospital stay, and improving functional recovery. The observed benefits are attributed to strategies such as early mobilization, optimized analgesia management, and reduction in opioid use. However, the variability of results between different types of surgery suggests that the effectiveness of ERAS depends on the complexity of the procedure and the clinical status of the patient. In addition, the hospital readmission rate still does not present a clear consensus, which reinforces the need for studies with prolonged follow-up to assess the safety of the protocol. Conclusion: The systematic review demonstrates that the ERAS protocol is effective in postoperative recovery from abdominal surgeries, especially in gastrointestinal and hepatic procedures. However, its applicability should be adjusted according to the surgical complexity and the individual conditions of the patient. The heterogeneity of the studies analyzed highlights the importance of robust randomized controlled trials and long-term studies to refine the implementation of ERAS and consolidate its clinical advantages.

DOI: https://doi.org/10.56238/sevened2024.039-033