PURPOSE Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. MATERIALS AND METHODS A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. RESULTS The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) - 3.46 d, 95% confidence interval (CI) - 4.94 to - 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61-0.94, p = 0.01] and time to defecation (MD - 1.37 d, 95% CI - 2.06 to - 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52-1.03, p = 0.07). CONCLUSION Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

中文翻译：

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根治性膀胱切除术术后的早期恢复：现有方案的综合评估和荟萃分析。

目的已发表了根治性膀胱切除术（RC）的不同的术后恢复（ERAS）方案（EP）。协议所包含的项目和具体措施的数量差异很大。材料与方法使用MedLine，Cochrane图书馆，Web of science和Google Scholar数据库对RC中的EP进行系统的综述和荟萃分析。提取，分析和比较协议的特定ERAS度量。汇总可获得的结局数据，包括住院时间，并发症，再入院率和排便时间。结果该检索共获得860项研究，其中25项研究定性，22项定量分析。24/25（96％）的EP中省略了口服肠道准备（BP），在22/25（88％）的EP中进行了最佳的输液管理，在21/25（84％）的患者中进行了早期动员（术后1天）。口香糖（n = 12，46％），甲氧氯普胺（n = 11，44％）和alvimopan（n = 6，24％）是预防术后肠梗阻的最常见措施。我们的荟萃分析显示，对于结局参数停留时间[平均差异（MD）-3.46 d，95％置信区间（CI）-4.94至-1.98，p <0.01]，并发症[赔率]，EPs的显着优势。比（OR）＝ 0.76，95％CI 0.61-0.94，p ＝ 0.01]和排便时间（MD-1.37d，95％CI-2.06至-0.69，p ＜0.01）。再入院率没有显着差异（OR = 0.73，95％CI 0.52-1.03，p = 0.07）。结论当前的EP专注于省略口服BP，早期动员，和优化的输液管理，尽管它们在预防术后肠梗阻的方法上有所不同。我们的荟萃分析显示了将这些方案引入临床实践的好处。