Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: Results from a systematic review and meta-analysis

Objective: The aim of this study was to establish if enhanced recovery after surgery (ERAS) and fast track surgery (FTS) protocols are associated with reduction in healthcare-associated infection (HAIs). Background: Evidence suggests that prevention strategies for HAIs should be multifaceted and transdisciplinary. ERAS and FTS protocols are collaborative approaches to perioperative care which reduce length of stay but may also be an effective strategy for reducing HAIs. Methods: We performed a meta-analysis of randomized trials involving either ERAS or FTS for abdominal or pelvic surgery. Primary outcome included postoperative incidence of 3 major HAIs: lung infection (LI), urinary tract infection (UTI), and surgical site infection (SSI). Results: Among all included trials, ERAS/FTS was associated with a significant reduction in postoperative LI [risk ratio (RR) = 0.38; 95% confidence interval (CI) = 0.23-0.61; P < 0.0001; I2 = 0%], UTI (RR = 0.42; 95% CI = 0.23-0.76; P=0.004; I2 =0%), and SSI (RR=0.75; 95% CI=0.58-0.98; P = 0.04; I2 = 0%) compared with conventional controls. Sensitivity analysis performed following the exclusion of high risk of bias publications did not appreciably affect these results. ERAS/FTS was also associated with a significant decrease in hospital length of stay (standard mean difference =-0.83; 95% CI=-0.92 to -0.75; P < 0.0001; P for heterogeneity <0.0001, I2 = 93%). Subgroup analysis of trials involving colorectal surgery and open incision also resulted in significant reduction in all 3 HAIs among ERAS/FTS compared with conventional counterparts. Conclusions: Our results suggest ERAS/FTS protocols are powerful tools to prevent HAIs. Further study is needed to establish the mechanism. Providers should consider adoption of similar transdisciplinary programs to reduce perioperative HAIs and at the same time improve the value of surgical care.