Closing the Gap: A Systematic Review and Meta-Analysis of Enhanced Recovery After Surgery Protocols in Primary Cleft Palate Repair

Abstract

Objective Assess the evidence for Enhanced Recovery After Surgery (ERAS) protocols in the cleft palate population. Design A systematic review of MEDLINE, Embase, Cochrane, and CINAHL databases for articles detailing the use of ERAS protocols in patients undergoing primary palatoplasty. Setting New York-Presbyterian Hospital. Patients/Participants Patients with cleft palate undergoing primary palatoplasty. Interventions Meta-analysis of reported patient outcomes in ERAS and control cohorts. Main Outcome Measure(s) Methodological quality of included studies, opioid use, postoperative length of stay (LOS), rate of return to emergency department (ED)/readmission, and postoperative complications. Results Following screening, 6 original articles were included; all were of Modified Downs & Black (MD&B) good or fair quality. A total of 354 and 366 were in ERAS and control cohorts, respectively. Meta-analysis of comparable ERAS studies showed a difference in LOS of 0.78 days for ERAS cohorts when compared to controls ( P < .05). Additionally, ERAS patients utilized significantly less postoperative opioids than control patients ( P < .05). Meta-analysis of the rate of readmission/return to ED shows no difference between ERAS and control groups ( P = .59). However, the lack of standardized reporting across studies limited the power of meta-analyses. Conclusions ERAS protocols for cleft palate repair offer many advantages for patients, including a significant decrease in the LOS and postoperative opioid use without elevating readmission and return to ED rates. However, this analysis was limited by the paucity of literature on the topic. Better standardization of data reporting in ERAS protocols is needed to facilitate pooled meta-analysis to analyze their effectiveness.