Table 1: Summary final table.
|
Author |
Year |
Sample size |
Study design |
Surgery type |
Outcome measures |
Control/Comparison Group |
Strengths |
Limitations |
Rating |
|
|
Bertelsen, et al. |
2020 |
122 |
Prospective cohort study |
Free flap |
Rates of: blood transfusion, flap complications, infection, readmission Overall LOS and ITU LOS
|
Historic patient cohort
|
Moderate size cohort Prospective ERAS data collection Tumour histology and flap types comparable between groups Matched control |
Not matched for age and perfomance status No long-term follow up Single centre study No compliance to pathway elements recorded |
2 |
|
|
Won, et al. |
2019 |
89 |
Prospective cohort study |
Free flap |
Start times of: adjuvant radiotherapy, oral feeding, mobilisation, complication rates, overall and ITU LOS |
Historic patient cohort
|
Prospective data collection Multiple relevent outcome measures
|
Small sample size Single centre study No compliance data No long-term follow up |
2 |
|
|
Kiong, et al. |
2020 |
400 |
Prospective cohort study |
Free flap |
Pain score, opioid usage, complications, overall LOS Rates of readmission |
Historic cohort 1:1 matched
|
Confounder correction through matched control Good size cohort Prospective data collection both control and ERAS |
Single-centre experience from a high volume specialist centre No compliance data or long-term follow up |
2 |
|
|
Jandali, et al. |
2019 |
185 |
Retrospective cohort study |
All major head and neck surgery |
Pain score, opioid usage, overall LOS, ITULOS
|
Historic patient cohort
|
Moderate size cohort Not only limited to free flap surgery
|
Retrospective data collection Significant number of participants in control group were using opioids pre-op and may have impacted on post-op analgesic requirements No compliance data, single centre study No long-term follow up |
3 |
|
|
Coyle, et al. |
2015 |
31 |
Service improvement project |
Free flap |
Compliance to pathway elements Overall LOS
|
No control comparison
|
Insight into the effect of compliance on LOS
|
No control for comparison Single centre study Small sample size No long-term follow up |
4 |
|
|
Bater, et al. |
2017 |
140 |
Prospective cohort study |
Free flap |
Overall LOS, complication rates, readmission rates, time to mobilisation
|
Historic patient cohort
|
Patients matched (propensity score matching) then log duration of stay was compared Prospective data collection
|
Single centre study No compliance data No long-term follow up
|
2 |
|
|
Dautremont, et al. |
2013 |
118 |
Prospective cohort study |
Free flap |
Rates of: Pneumonia, flap failure, ITU readmission. Time to decannulation Overall LOS |
Historic patient cohort
|
Prospective data collection Multiple relevent outcome measures Moderate size cohort
|
Not labelled as ERAS pathway Single centre study No compliance data No long-term follow up |
2 |
|
|
Morse, et al. |
2018 |
176 |
Prospective cohort study |
Free flap |
Overall LOS, ITU readmission, Hospital readmission, flap failure, post-op complications
|
Pre-pathway historic cohort vs. 'early' (year 1) vs. 'late' (year 2)
|
Matched analysis of each group to reduce selection bias was performed blinded to all outcome variables Moderate size cohort Prospective data collection |
Single centre study No compliance data No long-term follow up
|
2 |
|
|
Yeung, et al. |
2014 |
116 |
Prospective cohort study |
Free flap |
Overall LOS ITU LOS and readmission Timing to: decannulation, mobilisation, time on ventilator |
Historic patient cohort
|
Prospective data collection Multiple relevent outcome measures
|
Not labelled as ERAS pathway Single centre study No compliance data No long-term follow up |
2 |
|
|
Yetzer, et al. |
2017 |
66 |
Retrospective cohort study |
Free flap |
Overall LOS, proportion discharged within 7 days Post-op complications, rates of admission to ITU |
Surgeon A patients 2x cohorts historic 'pre' and ERAS cohort Surgeon B 2x cohorts following standard practice |
Comparison of pathway group with not only historic cohort but also contemporaneous group not using the pathway
|
Retrospective data collection Small sample size Not labelled as ERAS pathway
|
3 |
|
|
Dort, et al.
|
2020
|
434
|
Prospective cohort study
|
Free flap
|
Overall LOS, ITU LOS Time to: Enteral feed, TWOC, decannulation
|
Historic cohort vs. 'early' new pathway cohort vs. 'current' new pathway cohort |
Prospective data collection Good size cohort Multiple relevent outcome measures Includes compliance data |
Single centre study No long-term follow up
|
2 |
|
|
Sharkh, et al. |
2019 |
95 |
Retrospective cohort study |
Free flap |
Overall LOS, ITU LOS Readmission to hospital Flap failure rates |
Historic patient cohort
|
|
Retrospective data collection Single centre study No compliance data |
3 |
|
|
Mhawej, et al. |
2020 |
127 |
Retrospective cohort study |
Free Flap |
Overall LOS, readmission to hospital Complication rates
|
Historic patient cohort
|
Moderate size cohort
|
Pre-cohort double the size of post-pathway cohort Not labelled as ERAS pathway Retrospective data collection Single centre study |
3 |
|
|
Moreno, at al. |
2018 |
270 |
Retrospective cohort study |
Free flap |
Overall LOS, ITU LOS Care costs |
Historic patient cohort Vs.'transitional' group Vs. 'pathway group'
|
Good size cohort |
Not labelled as ERAS pathway Retrospective data collection Lack of randomisation of groups Familiarity with pathways over time |
3 |
|
|
|
may have impacted positively on results for later group, however no compliance data. Single centre study |
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|
|
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|
Clark, et al. |
2021 |
198 |
Retrospective cohort study |
Free and local flaps |
Pain scores, MME intake Blood transfusion rates Overall and ITU LOS Readmission rates |
Historic patient cohort
|
Data entry for both groups was double-blinded Assessment of pre-op opiod usage in both groups Good sample size
|
Single centre study No compliance data or long-term follow up
|
3 |
|
|
Hinther, et al. |
2021 |
138 |
Retrospective cohort study |
Free flap |
MME intake Pain control
|
Baseline group pre-MMA protocol vs post-MMA group
|
Moderate sample size Prospective data collection Variation between subjects was adjusted for |
Single centre study No compliance data or long-term follow up Variation in cohort sizes |
3 |
|
|
Twomey, et al. |
2021 |
445 |
Retrospective cohort study |
Free flap |
Timing of first mobilisation Overall LOS Complication rates |
Mobilisation within 24 hrs vs. within 48hrs and 72 hrs
|
Prospective data collection Good sample size Includes compliance data |
Single centre study
|
3 |