4.3. Strengths and limitations
The quality of available studies limited this review. Very few evaluated
the intervention itself, and uncertainty hampered the interpretation of
their results. We rated the overall quality of the evidence as moderate.
Most interventions were assessed based on two or three randomized
controlled trials for which the evidence quality ranged from low to
moderate. The main limitation in this body of evidence was imprecision,
mainly due to small sample sizes, variability in outcome measures, and
low event rates. Hence, it was not possible to pool the data (except for
blood loss) and the interpretation of results was difficult. Despite
these limitations, we believe the common elements in studies comparing
the intervention against its alternative coupled with the data from ERAS
pathway evaluation provide a good foundation upon which to build an
evidence-based recommendation. These allowed the panel to discuss the
predefined outcomes in the PICOS framework and reach agreement to
formulate the recommendation.