Improved recovery protocols in cardiac surgery: systematic review with metaanalysis of randomized clinical trails

Abstract

Introduction: Multiple efforts are made to include improved recovery protocols as an indicator of quality in care for surgical patients, under the premise of accelerating the recovery of patients, without this being detrimental to the care process, and thus guarantee high patient satisfaction. In view of this, the development of research supported by the best scientific and practical evidence is necessary.

Objective: To estimate, through the published literature, the effectiveness of the application of early recovery protocols on the perioperative evolution of patients who undergo cardiac surgical procedures.

Method: Randomized controlled clinical trials, published between January 2013 and May 2020, were included. The systematic review was carried out according to the recommendations of the Cochrane Library manual 5.1.0 for reviewers.

Results: Six studies were analyzed (687 patients/study group: 345, control group: 342). The methodological quality of most of the researches assessed was good. A superiority of the protocols is shown, since they are accompanied by a decrease in the incidence of perioperative complications (RR=0.61 [0.40, 0.93]). Similarly, they are related to the decrease in hospital stay (mean difference, random effect, was -2.98 [-3.31, -2.65]).

Conclusions: Despite the few studies included, the evidence suggests that these programs improve the perioperative outcome of patients.

Keywords: improved or early recovery; intensified recovery; cardiac surgery; clinical trials.