title: Effectiveness and implementation of enhanced recovery after surgery programmes: a rapid evidence synthesis.
abstract: OBJECTIVE
  To assess the evidence on the impact of enhanced recovery programmes for patients undergoing elective surgery in acute hospital settings in the UK.
  
  
  METHODS
  Rapid evidence synthesis. Eight databases were searched from 1990 to March 2013 without language restrictions. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. Systematic reviews, RCTs not included in the systematic reviews, economic evaluations and UK NHS cost analysis, implementation case studies and surveys of patient experience in a UK setting were eligible for inclusion.
  
  
  METHODS
  We assessed the impact of enhanced recovery programmes on health or cost-related outcomes, and assessed implementation case studies and patient experience in UK settings. Studies were quality assessed where appropriate using the Centre for Reviews and Dissemination Database of Abstracts of Reviews of Effects critical appraisal process.
  
  
  RESULTS
  17 systematic reviews and 12 additional RCTs were included. Ten relevant economic evaluations were included. No cost analysis studies were identified. Most of the evidence focused on colorectal surgery. 14 innovation case studies and 15 implementation case studies undertaken in National Health Service settings described factors critical to the success of an enhanced recovery programme. Evidence for colorectal surgery suggests that enhanced recovery programmes may reduce hospital stays by 0.5-3.5 days compared with conventional care. There were no significant differences in reported readmission rates. Other surgical specialties showed greater variation in reductions in length of stay reflecting the limited evidence identified. Findings relating to other outcomes were hampered by a lack of robust evidence and poor reporting.
  
  
  CONCLUSIONS
  There is consistent, albeit limited, evidence that enhanced recovery programmes can reduce length of patient hospital stay without increasing readmission rates. The extent to which managers and clinicians considering implementing enhanced recovery programmes in UK settings can realise savings will depend on length of stay achieved under their existing care pathway.
authors: Centre for Reviews and Dissemination, University of York, York, UK.
authors: Fiona
authors: F
authors: Paton
authors: Centre for Reviews and Dissemination, University of York, York, UK.
authors: Duncan
authors: D
authors: Chambers
authors: Centre for Reviews and Dissemination, University of York, York, UK.
authors: Paul
authors: P
authors: Wilson
authors: Centre for Reviews and Dissemination, University of York, York, UK.
authors: Alison
authors: A
authors: Eastwood
authors: Centre for Reviews and Dissemination, University of York, York, UK.
authors: Dawn
authors: D
authors: Craig
authors: Centre for Reviews and Dissemination, University of York, York, UK.
authors: Dave
authors: D
authors: Fox
authors: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: David
authors: D
authors: Jayne
authors: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: Erika
authors: E
authors: McGinnes
mesh_terms: D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D006801:Humans; D019990:Perioperative Care / Q000191:economics / Q000379:methods / Q000592:standards*; D015397:Program Evaluation; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
keywords: enhanced recovery; fast track; length of hospital stay