title: Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery.
abstract: BACKGROUND
  Health care systems provide care to increasingly complex and elderly patients. Colorectal surgery is a prime example, with high volumes of major procedures, significant morbidity, prolonged hospital stays, and unplanned readmissions. This situation is exacerbated by an exponential rise in costs that threatens the stability of health care systems. Enhanced recovery pathways (ERP) have been proposed as a means to reduce morbidity and improve effectiveness of care. We have reviewed the evidence supporting the implementation of ERP in clinical practice.
  
  
  METHODS
  Medline, Embase, and the Cochrane library were searched for randomized, controlled trials comparing ERP with traditional care in colorectal surgery. Systematic reviews and papers on ERP based on data published in major surgical and anesthesiology journals were critically reviewed by international contributors, experienced in the development and implementation of ERP.
  
  
  RESULTS
  A random-effect Bayesian meta-analysis was performed, including 6 randomized, controlled trials totalizing 452 patients. For patients adhering to ERP, length of stay decreased by 2.5 days (95% credible interval [CrI] -3.92 to -1.11), whereas 30-day morbidity was halved (relative risk, 0.52; 95% CrI, 0.36-0.73) and readmission was not increased (relative risk, 0.59; 95% CrI, 0.14-1.43) when compared with patients undergoing traditional care.
  
  
  CONCLUSIONS
  Adherence to ERP achieves a reproducible improvement in the quality of care by enabling standardization of health care processes. Thus, while accelerating recovery and safely reducing hospital stay, ERPs optimize utilization of health care resources. ERPs can and should be routinely used in care after colorectal and other major gastrointestinal procedures.
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH 44106-5047, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Adamina
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: George A
authors.initials: GA
authors.lastname: Tomlinson
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D001499:Bayes Theorem; D003107:Colorectal Surgery / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D006295:Health Resources / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome