University of Oulu

Bte Azahari Hidayah, Zheng An Toh, Ling Jie Cheng, Bin Daud Syahzarin, Yi Zhu, Tarja Pölkki, Honggu He, Vidyadhar Padmakar Mali, Enhanced recovery after surgery in children undergoing abdominal surgery: meta-analysis, BJS Open, Volume 7, Issue 1, February 2023, zrac147,

Enhanced recovery after surgery in children undergoing abdominal surgery : meta-analysis

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Author: Hidayah, Bte Azahari1,2,3; Toh, Zheng An1,2,3; Cheng, Ling Jie3,4;
Organizations: 1Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
2Division of Nursing, National University Hospital, Singapore
3National University Health System, Singapore
4Saw Swee Hock School of Public Health, National University of Singapore, Singapore
5Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
6Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
7Department of Children and Women, Oulu University Hospital, Oulu, Finland
8Department of Paediatric Surgery, National University Hospital, Singapore
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2023
Publish Date: 2023-02-15


Background: Enhanced recovery after surgery (ERAS) is a multimodal approach that streamlines patient processes before, during, and after surgery. The goal is to reduce surgical stress responses and improve outcomes; however, the impact of ERAS programmes in paediatric abdominal surgery remains unclear. The authors aimed to review the effectiveness of ERAS on clinical outcomes in children undergoing abdominal surgery.

Method: CINAHL, CENTRAL, Embase, ProQuest, PubMed, and Scopus were searched for relevant studies published from inception until January 2021. The length of hospital stay (LOS), time to oral intake, time to stool, complication rates, and 30-day readmissions were measured. Meta-analyses and subgroup analyses were conducted using RevMan 5.4 with a random-effects model.

Results: Among 2371 records from the initial search, 111 articles were retrieved for full-text screening and 12 were included for analyses. The pooled mean difference (MD) demonstrated reduced LOS (MD −1.96; 95 per cent c.i. −2.75 to −1.17), time to oral intake (MD −3.37; 95 per cent c.i. −4.84 to −1.89), and time to stool (MD −4.19; 95 per cent c.i. −6.37 to −2.02). ERAS reduced postoperative complications by half and 30-day readmission by 36 per cent. Subgroup analyses for continuous outcomes suggested that ERAS was more effective in children than adolescents.

Conclusion: ERAS was effective in improving clinical outcomes for paediatric patients undergoing abdominal surgery.

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Series: BJS open
ISSN: 2474-9842
ISSN-E: 2474-9842
ISSN-L: 2474-9842
Volume: 7
Issue: 1
Article number: zrac147
DOI: 10.1093/bjsopen/zrac147
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3123 Gynaecology and paediatrics
316 Nursing
Funding: The publication of this review was funded by the Department of Paediatric Surgery, National University Hospital, Singapore.
Copyright information: © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact