Safety and Efficacy of Enhanced Recovery After Surgery in Patients Undergoing Minimally Invasive Pneumonectomy: A Systematic Review and Meta-Analysis

Abstract Background: The ERAS program has been widely used in thoracic surgery, but its effectiveness and safety in patients undergoing minimally invasive pneumonectomy remains uncertain.Methods: We searched PubMed, Embase, the Cochrane Library, and Science Direct for studies published through April 5, 2021, that compared the Safety and Efficacy of ERAS versus conventional care after minimally invasive pneumonectomy. Outcome data, including length of stay, overall morbidity, and pulmonary complications, were extracted by two independent investigators and analyzed using STATA 15.1 software.Results: 9 studies representing 2,332 patients were eligible for our analysis. Compared to conventional care, patients receiving an ERAS program had a shorter hospital stay (SMD=-0.51, 95％CI: -0.77to-0.24), particularly postoperative hospital stay (SMD=-0.76, 95％CI: -1.07to-0.46), and lower incidence rates of overall complications (OR= 0.79, 95% CI: 0.64-0.97) and pulmonary complications (OR= 0.51, 95%CI: 0.34-0.77), and bore less hospitalization costs (SMD=-0.39, 95％CI：-0.52 to -0.25). But there was no difference in the frequency of readmission (OR=0.91, 95%CI: 0.57-1.45) and 30-day mortality (OR=0.50, 95％CI: 0.13-2.00) between patients accepting ERAS versus conventional care. In subgroup analysis, the incidence of overall complications in ERAS patients only undergoing minimally invasive lobectomy or segmentectomy was significantly lower versus non-ERAS individuals (OR=0.66, 95%CI: 0.50-0.89). But this difference was not statistically significant when compared to all ERAS patients (OR=0.93, 95%CI: 0.69-1.25).Conclusion: ERAS is safe and effective in patients receiving minimally invasive pneumonectomy. Stronger evidence from large-sample, multicenter RCTs of ERAS following pneumonectomy is needed for better efficacy assessment.