Enhanced recovery pathways as a way to reduce surgical morbidity.
OBJECTIVE
The aim of this review is to summarize important publications in enhanced recovery during 2010-2011 and to highlight key themes. Specifically, we focus on updated systematic reviews of high-quality clinical trials of enhanced recovery in colorectal surgery, exemplar studies of enhanced recovery in other specialties, and exploration of which elements of the enhanced recovery package might be associated with improved patient outcome.


RESULTS
An expanding evidence base of clinical trials and implementation evaluations supports the effectiveness of enhanced recovery programmes in improving outcome following major elective surgery. The majority of this literature derives from the study of patients undergoing colorectal surgery, but increasingly enhanced recovery is spreading to other surgical specialties. The combination of reduced length of hospital stay (a surrogate for morbidity) with no increase in readmissions to hospital suggests that morbidity is reduced with enhanced recovery. Inconsistency in morbidity reporting limits the value of pooling data between studies, but within study comparisons in general support this conclusion. Patients adhering to an enhanced recovery programme return to normal function faster than those following traditional care pathways.


CONCLUSIONS
Enhanced recovery adoption is likely to continue to grow (range of specialties and penetration within specialties). This progression is supported by the available published data.
Anaesthesia and Critical Care Research Unit, University Hospitals Southampton NHS Foundation Trust, UK. mike.grocott@soton.ac.uk
Michael P W
MP
Grocott
Daniel S
DS
Martin
Michael G
MG
Mythen
D003107:Colorectal Surgery / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome