Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice
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EDITORIAL
Open Access
Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice Michael Nunns1* , Joseph B. John2, John S. McGrath2,3, Liz Shaw1, Simon Briscoe1, Jo Thompson Coon1, Anthony Hemsley4, Christopher J. Lovegrove2,5, David Thomas2, Michael G. Mythen6 and Rob Anderson1
Abstract Multicomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas which lack research in the context of ERPs are patientreported outcome measures, patients with complex needs and assessment of factors pertaining to successful ERP implementation. The next generation of ERP studies should seek to develop our understanding in these key areas. Keywords: Enhanced recovery after surgery, ERAS, ERP, Prehabilitation, Rehabilitation, Elective surgery, Metaanalysis, Recovery, Complications, Elderly
Main text There is growing acceptance of the need to provide a standardised approach to peri-operative care, often tailored to the nature of the surgical intervention. Unwarranted variation is thought to impact both on clinical outcomes and patient safety. The cost of health care is growing exponentially and, at the same time, healthcare budgets have failed to keep pace. Enhanced recovery programmes (ERPs) are now established as multicomponent interventions that afford the opportunity to improve the quality of clinical care whilst reducing overall costs. These ‘packages’ of care aimed at accelerating recovery and reducing length of stay (LOS) have become * Correspondence: [email protected] 1 Exeter HS&DR Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke’s Campus, Heavitree Road, Exeter, Devon EX1 2 LU, UK Full list of author information is available at the end of the article
increasingly embedded across healthcare systems worldwide. Our recent systematic review and meta-analysis, commissioned by the National Institute for Health Research (NIHR), identified the broad range of interventions of this nature that have been studied in the UK and abroad (Nunns et al. 2019). It outlines how these interventions have been shown to improve recovery without significantly increasing the risk of complications or re-admissions. But importantly, it has furthered our understanding of which interventions, aspects of the ‘adoption’ process and key outcomes warrant rigorous assessment in future studies on account of the current paucity of relevant data available in the litera
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