title: Enhanced recovery programmes in hepatobiliary and pancreatic surgery: a systematic review.
abstract: BACKGROUND
  The terms 'enhanced recovery after surgery', 'enhanced recovery programme' (ERP) and 'fast track surgery' refer to multimodal strategies aiming to streamline peri-operative care pathways, to maximise effectiveness and minimise costs. While the results of ERP in colorectal  surgery are well reported, there have been no reviews examining if these concepts could be applied safely to hepatopancreatobiliary (HPB) surgery. The aim of this systematic review was to appraise the current evidence for ERP in HPB surgery.
  
  
  METHODS
  A MEDLINE ® literature search was  undertaken using the keywords 'enhanced recovery', 'fast-track', 'peri-operative', 'surgery', 'pancreas' and 'liver' and their derivatives such as 'pancreatic' or 'hepatic'. The primary endpoint was length of post-operative hospital stay. Secondary endpoints were morbidity, mortality and readmission  rate.
  
  
  RESULTS
  Ten articles were retrieved describing an ERP. ERP protocols varied slightly between studies. A reduction in length of stay was a consistent finding following the incorporation of ERP when compared with historical controls. This was not at the expense of increased rates  of readmission, morbidity or mortality in any study.
  
  
  CONCLUSIONS
  The introduction of an ERP in HPB surgery appears safe and feasible. Currently, many of the principles of the multimodal pathway are derived from the colorectal ERP and distinct differences exist, which may impede its implementation  in HPB surgery.
authors.affiliation: University Hospitals of Leicester NHS Trust, UK. tch2@doctors.org.uk
authors.forename: T C
authors.initials: TC
authors.lastname: Hall
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
authors.forename: D K
authors.initials: DK
authors.lastname: Bilku
authors.forename: M S
authors.initials: MS
authors.lastname: Metcalfe
authors.forename: G
authors.initials: G
authors.lastname: Garcea
mesh_terms: D001649:Bile Duct Diseases / Q000534:rehabilitation / Q000601:surgery*; D001652:Bile Ducts / Q000601:surgery*; D002985:Clinical Protocols; D003289:Convalescence; D006801:Humans; D007902:Length of Stay; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D010179:Pancreas / Q000601:surgery*; D010182:Pancreatic Diseases / Q000534:rehabilitation / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods