Enhanced recovery pathways optimize health outcomes and resource utilization

A meta-analysis of randomized controlled trials in colorectal surgery

Michel Adamina, Henrik Kehlet, George A. Tomlinson, Anthony J. Senagore, Conor P. Delaney

Research output: Contribution to journalReview article

321 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)830-840
Number of pages11
JournalSurgery
Volume149
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

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Colorectal Surgery
Health Resources
Meta-Analysis
Randomized Controlled Trials
Length of Stay
Morbidity
Delivery of Health Care
Critical Pathways
Bayes Theorem
Anesthesiology
Quality of Health Care
Libraries
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Enhanced recovery pathways optimize health outcomes and resource utilization : A meta-analysis of randomized controlled trials in colorectal surgery. / Adamina, Michel; Kehlet, Henrik; Tomlinson, George A.; Senagore, Anthony J.; Delaney, Conor P.

In: Surgery, Vol. 149, No. 6, 06.2011, p. 830-840.

Research output: Contribution to journalReview article

Adamina, Michel ; Kehlet, Henrik ; Tomlinson, George A. ; Senagore, Anthony J. ; Delaney, Conor P. / Enhanced recovery pathways optimize health outcomes and resource utilization : A meta-analysis of randomized controlled trials in colorectal surgery. In: Surgery. 2011 ; Vol. 149, No. 6. pp. 830-840.
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