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CC BY 4.0 · Avicenna J Med 2025; 15(02): 080-085
DOI: 10.1055/s-0045-1808072
Original Article

Enhanced Recovery after Pediatric Cardiac Surgery: A Meta-Analysis

Osama Abu-Shawer
1   Anesthesiology and Perioperative Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Abdel-Rahman E'mar
2   Departement of Pediatrics, Cleveland Clinic Foundation, Cleveland, Ohio, United States
,
Abdel-Rahman Jaber
3   School of Medicine, University of Jordan, Amman, Jordan
,
Shatha Tailakh
3   School of Medicine, University of Jordan, Amman, Jordan
,
Amer Abu-Shawer
3   School of Medicine, University of Jordan, Amman, Jordan
,
Caroline Al-Haddadin
1   Anesthesiology and Perioperative Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
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Funding None.
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Abstract

Background

The Enhanced Recovery After Surgery (ERAS) protocols are a set of steps taken before, during, and after surgery to improve patient care and outcomes. While ERAS is well known for its benefits in various surgeries, its application in pediatric cardiac surgery is relatively new. With the recent emergence of studies on its implementation in pediatric cardiac surgery, this study is the first to systematically review the current evidence on the efficacy of ERAS in the field.

Methods

A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently searched PubMed, Cochrane, Google Scholar, Web of Science, Embase, and Scopus databases for comparative studies with control groups that described the use of ERAS in all types of pediatric cardiac surgeries from 2000 to 2024. The data collected included study design, patient demographics, elements of the ERAS protocols, and postoperative outcomes. The random-effects model was used to calculate the pooled odds ratios (ORs) and mean differences (MDs) with the corresponding confidence intervals (CIs) for proportional and continuous variables, respectively.

Results

Five studies, involving 1,008 patients, were included in the final analysis: three randomized controlled trials (RCTs), one retrospective cohort, and one case-control study. The ERAS protocols were applied in 430 (43%) patients, and standard perioperative care was applied in 578 (57%) patients. The analysis revealed that implementing the ERAS protocol significantly reduced ICU length of stay (I 2 = 98.26%; MD = −1.441; 95% CI: −2.610 to −0.273; p = 0.016). The ERAS group had a comparable rate of postoperative complications to the standard care group (I 2 = 15.3%; OR: 0.889; 95% CI: 0.622–1.269; p = 0.516).

Conclusions

The ERAS protocols in pediatric cardiac surgery appear to be safe and effective in improving certain short-term outcomes. However, evidence is limited due to the small number of studies. Further multicenter RCTs that fully incorporate the ERAS protocol elements and assess both immediate and long-term outcomes are needed.

Keywords

enhanced recovery - ERAS - pediatric cardiac surgery

Authors' Contributions

The concept and design of the study were developed by O.A-S., A.R.J., S.T., A.A-S., and C.A.H. Acquisition, analysis, and interpretation of data were done by O.A-S., A.R.E., and C.A.H. Drafting of the manuscript was done by O.A-S. and A.R.J. Critical review of the manuscript for important intellectual content was done by O.A-S., A.R.E., S.T., A.A-S., and C.A.H. Supervision of the study was done by C.A.H.


All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work.


Supplementary Material



Publication History

Article published online:
06 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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