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.