Systematic review and meta-analysis of enhanced recovery programmes in surgical patients

Nicholson, A and Lowe, M C and Parker, Joshua and Lewis, S R and Alderson, P and Smith, A F (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. British Journal of Surgery, 101 (3). pp. 172-88. ISSN 0007-1323

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Abstract

BACKGROUND: Enhanced recovery programmes (ERPs) have been developed over the past 10 years to improve patient outcomes and to accelerate recovery after surgery. The existing literature focuses on specific specialties, mainly colorectal surgery. The aim of this review was to investigate whether the effect of ERPs on patient outcomes varies across surgical specialties or with the design of individual programmes. METHODS: MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials were searched from inception to January 2013 for randomized or quasi-randomized trials comparing ERPs with standard care in adult elective surgical patients. RESULTS: Thirty-eight trials were included in the review, with a total of 5099 participants. Study design and quality was poor. Meta-analyses showed that ERPs reduced the primary length of stay (standardized mean difference -1·14 (95 per cent confidence interval -1·45 to -0·85)) and reduced the risk of all complications within 30 days (risk ratio (RR) 0·71, 95 per cent c.i. 0·60 to 0·86). There was no evidence of a reduction in mortality (RR 0·69, 95 per cent c.i. 0·34 to 1·39), major complications (RR 0·95, 0·69 to 1·31) or readmission rates (RR 0·96, 0·59 to 1·58). The impact of ERPs was similar across specialties and there was no consistent evidence that elements included within ERPs affected patient outcomes. CONCLUSION: ERPs are effective in reducing length of hospital stay and overall complication rates across surgical specialties. It was not possible to identify individual components that improved outcome. Qualitative synthesis may be more appropriate to investigate the determinants of success.

Item Type:
Journal Article
Journal or Publication Title:
British Journal of Surgery
Additional Information:
© 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700/2746
Subjects:
ID Code:
171576
Deposited By:
Deposited On:
14 Jul 2022 12:45
Refereed?:
Yes
Published?:
Published
Last Modified:
14 Jul 2022 12:45