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Enhanced recovery pathways as a way to reduce surgical morbidity

Grocott, Michael P.W.a,b,c; Martin, Daniel S.d,e; Mythen, Michael G.e,f

Current Opinion in Critical Care: August 2012 - Volume 18 - Issue 4 - p 385–392
doi: 10.1097/MCC.0b013e3283558968

Purpose of review The aim of this review is to summarize important publications in enhanced recovery during 2010–2011 and to highlight key themes. Specifically, we focus on updated systematic reviews of high-quality clinical trials of enhanced recovery in colorectal surgery, exemplar studies of enhanced recovery in other specialties, and exploration of which elements of the enhanced recovery package might be associated with improved patient outcome.

Recent findings An expanding evidence base of clinical trials and implementation evaluations supports the effectiveness of enhanced recovery programmes in improving outcome following major elective surgery. The majority of this literature derives from the study of patients undergoing colorectal surgery, but increasingly enhanced recovery is spreading to other surgical specialties. The combination of reduced length of hospital stay (a surrogate for morbidity) with no increase in readmissions to hospital suggests that morbidity is reduced with enhanced recovery. Inconsistency in morbidity reporting limits the value of pooling data between studies, but within study comparisons in general support this conclusion. Patients adhering to an enhanced recovery programme return to normal function faster than those following traditional care pathways.

Summary Enhanced recovery adoption is likely to continue to grow (range of specialties and penetration within specialties). This progression is supported by the available published data.

aAnaesthesia and Critical Care Research Unit, University Hospitals Southampton NHS Foundation Trust

bIntegrative Physiology and Critical Illness Group, Division of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton

cNIHR Respiratory Biomedical Research Unit, Southampton Centre for Biomedical Research, University Hospitals Southampton NHS Foundation Trust/University of Southampton, Southampton

dUCL Division of Surgery and Interventional Science, Royal Free Hospital

eAnaesthetics Department, UCL Centre for Anaesthesia, University College London

fUniversity College London Hospitals NHS Foundation Trust, London, UK

Correspondence to Michael P. W. Grocott, CE.93 Mailpoint 24, E-level Centre Block, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK. Tel: +44 2380 8449; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.