In a momentous systematic review and meta-analysis featured recently in 'PLoS One', the Enhanced Recovery After Surgery (ERAS) protocol emerged as a transformative force in patients with chronic rhinosinusitis (CRS) experiencing endoscopic sinus surgery (ESS).

Yuqi Wu and colleagues assessed the safety and efficacy of ERAS in the perioperative management of patients with CRS undergoing ESS.

A database search was performed to look for randomized trials (RCTs) about the ERAS effectiveness and safety in ESS perioperative management of CRS patients. These included searching PubMed, EMBASE, Cochrane CENTRAL, Web of Science, Ovid, China National Knowledge Infrastructure, Chinese BioMedical Literature Database and VIP Database. The Cochrane Collaboration tool assessed the methodological quality of the RCTs under consideration.

The GRADE tool i.e. Grading of Recommendations, Assessment, Development and Evaluation tool helped assess the quality of the evidence. The Egger’s rank, Begg’s, and funnel plot tests were used to capture the possible publication bias. Analyzing 28 studies involving 2636 patients, the results paint a compelling picture of ERAS's superiority over standard care (SC) in various facets of perioperative management. The ERAS group exhibited noteworthy advantages, including:

• Length of Stay: ERAS outperformed SC, showcasing a reduction in length of stay (MD = -2.50, 95% CI: -3.04 to -1.97).
• Pain Scores: ERAS demonstrated significantly lower pain scores (MD = -1.07, 95% CI: -1.46 to -0.67).
• Anxiety Score: ERAS led to a substantial reduction in anxiety scores (SMD = -2.13, 95% CI: -2.83 to -1.44).
• Depression Score: ERAS resulted in a marked decrease in depression scores (SMD = -2.42, 95% CI: -3.13 to -1.71).
• Hospitalization Expenses: The ERAS group experienced reduced hospitalization expenses.
• Quality of Life: ERAS significantly improved the overall quality of life.

Also, a significantly lower incidence of adverse events (overall complications, postoperative nausea and vomiting, face edema, pain in the lower back, urinary retention and hemorrhage) was reported. Even though the ERAS protocol was found to be effective and safe in CRS patients who undergo ESS, the elucidation of the results should be done carefully due to inadequate methodological quality studies. Future high-quality, multiple-center, and large-sample studies are needed to authenticate its clinical effectiveness, concluded the study investigators.