Background
Health care systems provide care to increasingly complex and elderly patients. Colorectal
surgery is a prime example, with high volumes of major procedures, significant morbidity,
prolonged hospital stays, and unplanned readmissions. This situation is exacerbated
by an exponential rise in costs that threatens the stability of health care systems.
Enhanced recovery pathways (ERP) have been proposed as a means to reduce morbidity
and improve effectiveness of care. We have reviewed the evidence supporting the implementation
of ERP in clinical practice.
Methods
Medline, Embase, and the Cochrane library were searched for randomized, controlled
trials comparing ERP with traditional care in colorectal surgery. Systematic reviews
and papers on ERP based on data published in major surgical and anesthesiology journals
were critically reviewed by international contributors, experienced in the development
and implementation of ERP.
Results
A random-effect Bayesian meta-analysis was performed, including 6 randomized, controlled
trials totalizing 452 patients. For patients adhering to ERP, length of stay decreased
by 2.5 days (95% credible interval [CrI] −3.92 to −1.11), whereas 30-day morbidity
was halved (relative risk, 0.52; 95% CrI, 0.36–0.73) and readmission was not increased
(relative risk, 0.59; 95% CrI, 0.14–1.43) when compared with patients undergoing traditional
care.
Conclusion
Adherence to ERP achieves a reproducible improvement in the quality of care by enabling
standardization of health care processes. Thus, while accelerating recovery and safely
reducing hospital stay, ERPs optimize utilization of health care resources. ERPs can
and should be routinely used in care after colorectal and other major gastrointestinal
procedures.
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Article info
Publication history
Published online: January 18, 2011
Accepted:
November 9,
2010
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
