Di Wang, Rongkun Zhu, Xiaoxuan Ma, Jing Zhao, Cong Shang, Xiwei Hao
ERAS protocols are effective and safe for children undergoing laparoscopic appendectomy, significantly reducing hospital stay, accelerating gastrointestinal recovery, alleviating postoperative pain, and lowering complication risk. These findings support broader adoption of ERAS in pediatric emergency surgical practice, while acknowledging that some components may already be integrated into routine care in certain settings, and that further optimization through day-surgery pathways is warranted for uncomplicated cases.
BACKGROUND: Acute appendicitis is the most common surgical emergency in children, and laparoscopic appendectomy has become the standard of care. Enhanced recovery after surgery (ERAS) protocols have demonstrated significant benefits in adult populations, but their application in pediatric emergency surgery remains less established.
OBJECTIVE: To systematically evaluate the efficacy and safety of ERAS protocols compared with traditional perioperative care in children undergoing laparoscopic appendectomy for acute appendicitis.
METHODS: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, Embase, and China National Knowledge Infrastructure (CNKI) from inception to March 2026. Randomized controlled trials (RCTs) comparing ERAS protocols with traditional perioperative care in pediatric patients undergoing laparoscopic appendectomy were included. The primary outcomes were postoperative hospital stay and time to first flatus; secondary outcomes included postoperative pain scores and total complications. Meta-analysis was performed using RevMan 5.4, with mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. Heterogeneity was assessed using the I2 statistic.
RESULTS: Eight RCTs comprising 1,135 pediatric patients were included. ERAS protocols significantly reduced postoperative hospital stay (MD: -2.04 days, 95% CI: -2.74 to -1.34, P < 0.00001, I2 = 96%), accelerated time to first flatus (MD: -7.51 h, 95% CI: -11.00 to -4.03, P < 0.0001, I2 = 99%), alleviated postoperative pain (MD: -1.70 on VAS 0-10, 95% CI: -2.72 to -0.68, P = 0.001, I2 = 99%), and reduced the risk of total postoperative complications (RR: 0.29, 95% CI: 0.15 to 0.58, P = 0.03, I2 = 54%). Sensitivity analyses confirmed the robustness of the findings.
CONCLUSIONS: ERAS protocols are effective and safe for children undergoing laparoscopic appendectomy, significantly reducing hospital stay, accelerating gastrointestinal recovery, alleviating postoperative pain, and lowering complication risk. These findings support broader adoption of ERAS in pediatric emergency surgical practice, while acknowledging that some components may already be integrated into routine care in certain settings, and that further optimization through day-surgery pathways is warranted for uncomplicated cases.