Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009-2012.
BACKGROUND
The UK Department of Health Enhanced Recovery Partnership Programme collected data on 24 513 surgical patients in the UK from 2009-2012. Enhanced Recovery is an approach to major elective surgery aimed at minimizing perioperative stress for the patient. Previous studies have shown Enhanced Recovery to be associated with reduced hospital length of stay and perioperative morbidity.


METHODS
In this national clinical audit, National Health Service hospitals in the UK were invited to submit patient-level data. The data regarding length of stay and compliance with each element of Enhanced Recovery protocols for colorectal, orthopaedic, urological and gynaecological surgery patients were analysed. The relationship between Enhanced Recovery protocol compliance and length of stay was measured.


RESULTS
From 16 267 patients from 61 hospital trusts, three out of four surgical specialties showed Enhanced Recovery, compliance being weakly associated with shorter length of stay (correlation coefficients -0.18, -0.14, -0.25 in colorectal, orthopaedics and gynaecology respectively). At a cut-off of 80% compliance, good compliance was associated with two, one and three day reductions in median length of stay respectively in colorectal, orthopaedic and urological surgeries, with no saving in gynaecology.


CONCLUSIONS
This study is the largest assessment of the relationship between Enhanced Recovery protocol compliance and outcome in four surgical specialties. The data suggest that higher compliance with an Enhanced Recovery protocol has a weak association with shorter length of stay. This suggests that changes in process, resulting from highly protocolised pathways, may be as important in reducing perioperative length of stay as any individual element of Enhanced Recovery protocols in isolation.
The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK.
J C
JC
Simpson
The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK.
S R
SR
Moonesinghe
The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK Anaesthesia and Critical Care Research Unit, University Hospitals Southampton; Integrative Physiology and Critical Illness Group, University of Southampton and University Hospital Southampton, University of Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK.
M P W
MP
Grocott
Homerton Hospital, Homerton Row, London, UK.
M
M
Kuper
National Cancer Action Team, NHS, London, UK.
A
A
McMeeking
The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK.
C M
CM
Oliver
The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK.
M J
MJ
Galsworthy
The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK m.mythen@ucl.ac.uk.
M G
MG
Mythen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D017558:Elective Surgical Procedures; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000517:prevention & control*; D015397:Program Evaluation / Q000379:methods / Q000706:statistics & numerical data*; D020127:Recovery of Function; D006113:United Kingdom; D055815:Young Adult
anesthesia; general surgery; perioperative care