title: Factors predicting outcome from enhanced recovery programmes in laparoscopic colorectal surgery: a systematic review.
abstract: To perform a systematic review of published literature for the factors reported to predict outcomes of enhanced recovery after surgery (ERAS) programmes following laparoscopic colorectal surgery.
  
  
  
  ERAS programmes and the use of laparoscopy have been widely adopted in colorectal surgery bringing short-term patient benefit. However, there is a minority of patients that do not benefit from these strategies and their identification is not well characterised. The factors that underpin outcomes from ERAS programmes for laparoscopic patients are not understood.
  
  
  
  A systematic search of the MEDLINE, Embase and Cochrane databases was conducted to identify suitable articles published between 2000 and 2015. The search strategy captured terms for ERAS, colorectal resection, prediction and outcome measures.
  
  
  
  Thirty-four studies containing 10,861 laparoscopic resections were included. Thirty-one (91 %) studies were confined to elective cases. Predictive analysis of outcome was most frequently based on length of stay (LOS), morbidity and readmission which were the main outcome measures of 29 (85 %), 26 (76 %) and 18 (53 %) of the included studies, respectively. Forty-seven percentage of included studies investigated the impact of ERAS programme compliance on these outcomes. Reduced protocol compliance was the most frequently identified modifiable predictive factor for adverse LOS, morbidity and readmission.
  
  
  
  Protocol compliance is the most frequently reported predictive factor for outcomes of ERAS programmes following laparoscopic colorectal resection. Reduced compliance increases LOS, morbidity and readmission to hospital. The impact of compliance with individual ERAS protocol elements is insufficiently studied, and the lack of a standardised framework for evaluating ERAS programmes makes it difficult to draw definite conclusions about which factors exert the greatest impact on outcome after laparoscopic colorectal resection.
authors.affiliation: Colorectal Surgical Unit, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Messenger
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Curtis
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Jones
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Jones
authors.affiliation: Department of General Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Smart
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK. nader.francis@ydh.nhs.uk.
authors.forename: Nader K
authors.initials: NK
authors.lastname: Francis
mesh_terms: D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D019983:Guideline Adherence; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*
keywords: Colorectal; ERAS; Enhanced recovery; Outcome; Prediction