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Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy: A systematic review and meta-analysis

Objective: To compare the benefits of enhanced recovery after surgery (ERAS) pathways with traditional pathways for adult patients undergoing laparoscopic appendectomy. Methods: We looked for publications using the keywords “Enhanced Recovery After Surgery,” “Fast-track Surgery,” “Laparoscopic Appendectomy,” and “Laparoscopic Appendicectomy” in PubMed/Medline, Embase, and the Cochrane library. Operative time, lesser length of stay, oral intake timing, readmission rate, pain/satisfaction levels, readmission rate, and surgical site infections were recorded and analyzed. Results: A total of 95 articles from registers and 161 articles from databases were identified. Three eligible studies were included. The ERAS pathways had a lesser length of stay [Z=2.06, MD= -1.05, 95% CI=(-2.04, -0.05), P=0.04] and an earlier start to postoperative feeds [Z=6.22, MD= -267.49, 95% CI=(-351.80, -183.19), P<001]. Conclusions: ERAS pathways have a shorter length of stay and earlier postoperative feed initiation for adult patients undergoing laparoscopic appendectomy compared with standard care. Both approaches have similar operative time, surgical site infection incidence, and readmission rate. Clinical registration: This review is registered with INPLASY202280005.