This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Systematic review of outcomes used to evaluate enhanced recovery after surgery. BJS 2014; 101: 159-171.

Published: 27th January 2014

Authors: A. Neville, L. Lee, I. Antonescu, N. E. Mayo, M. C. Vassiliou, G. M. Fried et al.

Background

Enhanced recovery pathways (ERPs) aim to improve patient recovery. However, validated outcome measures to evaluate this complex process are lacking. The objective of this review was to identify how recovery is measured in ERP studies and to provide recommendations for the design of future studies.

Method

A systematic search of MEDLINE, Embase and Cochrane databases was conducted. Prospective studies evaluating ERPs compared with traditional care in abdominal surgery published between 2000 and 2013 were included. All reported outcomes were classified into categories: biological and physiological variables, symptom status, functional status, general health perceptions and quality of life (QoL). The phase of recovery measured was defined as baseline, intermediate (in hospital) and late (following discharge).

Results

A total of 38 studies were included based on the systematic review criteria. Biological or physiological variables other than postoperative complications were reported in 30 studies, and included return of gastrointestinal function (25 studies), pulmonary function (5) and physical strength (3). Patient‐reported symptoms, including pain (16 studies) and fatigue (9), were reported less commonly. Reporting of functional status outcomes, including mobilization (16 studies) and ability to perform activities of daily living (4), was similarly uncommon. Health aspects of QoL were reported in only seven studies. Length of follow‐up was generally short, with 24 studies reporting outcomes within 30 days or less. All studies documented in‐hospital outcomes (intermediate phase), but only 17 reported postdischarge outcomes (late phase) other than complications or readmission.

Conclusion

Patient‐reported outcomes, particularly postdischarge functional status, were not commonly reported. Future studies of the effectiveness of ERPs should include validated, patient‐reported outcomes to estimate better their impact on recovery, particularly after discharge from hospital.

Full text

You may also be interested in

Leading article

Network meta‐analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia.

Authors: J. H. H. Olsen, S. Öberg, K. Andresen, T. W. Klausen, J. Rosenberg

Original article

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons’ national registry. BJS 2019; 106: 1495-1503.

Authors: N. Patel, R. J. Egan, B. R. Carter, D. M. Scott‐Coombes, M. J. Stechman, A. Afzaal et al.

Systematic review of outcomes used to evaluate enhanced recovery after surgery. BJS 2014; 101: 159-171.

Background

Method

Results

Conclusion

You may also be interested in

A good surgical death. BJS 2019; 106: 1427-1428.

Randomized controlled trial of plain English and visual abstracts for disseminating surgical research via social media.

Systematic review of the current status of cadaveric simulation for surgical training.

Network meta‐analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia.

Effect of donor nephrectomy time during circulatory‐dead donor kidney retrieval on transplant graft failure.

Diagnostic performance of MRI and histology in assessment of deep lipomatous tumours.

Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury.

Trauma models to identify major trauma and mortality in the prehospital setting.

5G‐assisted telementored surgery.

Validation of the Norwegian survival prediction model in trauma (NORMIT) in Swedish trauma populations.

Human model of burn injury that quantifies the benefit of cooling as a first aid measure. BJS 2019; 106: 1472-1479.

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons’ national registry. BJS 2019; 106: 1495-1503.