Enhanced recovery protocols for adults undergoing colorectal surgery

A Systematic Review and Meta-analysis

Nancy L. Greer, William P. Gunnar, Philipp Dahm, Alice E. Lee, Roderick MacDonald, Aasma Shaukat, Shahnaz Sultan, Timothy J Wilt

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Enhanced surgical recovery protocols are designed to reduce hospital length of stay and health care costs. OBJECTIVE: This study aims to systematically review and summarize evidence from randomized and controlled clinical trials comparing enhanced recovery protocols versus usual care in adults undergoing elective colorectal surgery with emphasis on recent trials, protocol components, and subgroups for surgical approach and colorectal condition. DATA SOURCES: MEDLINE from 2011 to July 2017; reference lists of existing systematic reviews and included studies were reviewed to identify all eligible trials published before 2011. STUDY SELECTION: English language trials comparing a protocol of preadmission, preoperative, intraoperative, and postoperative components with usual care in adults undergoing elective colorectal surgery were selected. INTERVENTION: The enhanced recovery protocol for colorectal surgery was investigated. MAIN OUTCOME MEASURES: Length of stay, perioperative morbidity, mortality, readmission within 30 days, and surgical site infection were the primary outcomes measured. RESULTS: Twenty-five trials of open or laparoscopic surgery for cancer or noncancer conditions were included. Enhanced recovery protocols consisted of 4 to 18 components. Few studies fully described the various components. Length of stay (mean reduction, 2.6 days; 95% CI, –3.2 to –2.0) and risk of overall perioperative morbidity (risk ratio, 0.66; 95% CI, 0.54–0.80) were lower in enhanced recovery protocol groups than in usual care groups (moderate-quality evidence). All-cause mortality (rare), readmissions, and surgical site infection rates were similar between protocol groups (low-quality evidence). In predefined subgroup analyses, findings did not vary by surgical approach (open vs laparoscopic) or colorectal condition. LIMITATIONS: Protocols varied across studies and little information was provided regarding compliance with, or implementation of, specific protocol components. CONCLUSIONS: Enhanced recovery protocols for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events. Evidence was insufficient regarding which components, or component combinations, are key to improving patient outcomes.

Original languageEnglish (US)
Pages (from-to)1108-1118
Number of pages11
JournalDiseases of the colon and rectum
Volume61
Issue number9
DOIs
StatePublished - Jan 1 2018

Fingerprint

Colorectal Surgery
Meta-Analysis
Length of Stay
Surgical Wound Infection
Morbidity
Mortality
Clinical Protocols
MEDLINE
Health Care Costs
Laparoscopy
Language
Randomized Controlled Trials
Odds Ratio
Neoplasms

Keywords

  • Colorectal surgery
  • Enhanced recovery
  • Patient outcomes
  • Systematic review

Cite this

Enhanced recovery protocols for adults undergoing colorectal surgery : A Systematic Review and Meta-analysis. / Greer, Nancy L.; Gunnar, William P.; Dahm, Philipp; Lee, Alice E.; MacDonald, Roderick; Shaukat, Aasma; Sultan, Shahnaz; Wilt, Timothy J.

In: Diseases of the colon and rectum, Vol. 61, No. 9, 01.01.2018, p. 1108-1118.

Research output: Contribution to journalArticle

Greer, Nancy L. ; Gunnar, William P. ; Dahm, Philipp ; Lee, Alice E. ; MacDonald, Roderick ; Shaukat, Aasma ; Sultan, Shahnaz ; Wilt, Timothy J. / Enhanced recovery protocols for adults undergoing colorectal surgery : A Systematic Review and Meta-analysis. In: Diseases of the colon and rectum. 2018 ; Vol. 61, No. 9. pp. 1108-1118.
@article{ef3dc921db214a7fa86eb8c44fd47a67,
title = "Enhanced recovery protocols for adults undergoing colorectal surgery: A Systematic Review and Meta-analysis",
abstract = "BACKGROUND: Enhanced surgical recovery protocols are designed to reduce hospital length of stay and health care costs. OBJECTIVE: This study aims to systematically review and summarize evidence from randomized and controlled clinical trials comparing enhanced recovery protocols versus usual care in adults undergoing elective colorectal surgery with emphasis on recent trials, protocol components, and subgroups for surgical approach and colorectal condition. DATA SOURCES: MEDLINE from 2011 to July 2017; reference lists of existing systematic reviews and included studies were reviewed to identify all eligible trials published before 2011. STUDY SELECTION: English language trials comparing a protocol of preadmission, preoperative, intraoperative, and postoperative components with usual care in adults undergoing elective colorectal surgery were selected. INTERVENTION: The enhanced recovery protocol for colorectal surgery was investigated. MAIN OUTCOME MEASURES: Length of stay, perioperative morbidity, mortality, readmission within 30 days, and surgical site infection were the primary outcomes measured. RESULTS: Twenty-five trials of open or laparoscopic surgery for cancer or noncancer conditions were included. Enhanced recovery protocols consisted of 4 to 18 components. Few studies fully described the various components. Length of stay (mean reduction, 2.6 days; 95{\%} CI, –3.2 to –2.0) and risk of overall perioperative morbidity (risk ratio, 0.66; 95{\%} CI, 0.54–0.80) were lower in enhanced recovery protocol groups than in usual care groups (moderate-quality evidence). All-cause mortality (rare), readmissions, and surgical site infection rates were similar between protocol groups (low-quality evidence). In predefined subgroup analyses, findings did not vary by surgical approach (open vs laparoscopic) or colorectal condition. LIMITATIONS: Protocols varied across studies and little information was provided regarding compliance with, or implementation of, specific protocol components. CONCLUSIONS: Enhanced recovery protocols for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events. Evidence was insufficient regarding which components, or component combinations, are key to improving patient outcomes.",
keywords = "Colorectal surgery, Enhanced recovery, Patient outcomes, Systematic review",
author = "Greer, {Nancy L.} and Gunnar, {William P.} and Philipp Dahm and Lee, {Alice E.} and Roderick MacDonald and Aasma Shaukat and Shahnaz Sultan and Wilt, {Timothy J}",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/DCR.0000000000001160",
language = "English (US)",
volume = "61",
pages = "1108--1118",
journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Enhanced recovery protocols for adults undergoing colorectal surgery

T2 - A Systematic Review and Meta-analysis

AU - Greer, Nancy L.

AU - Gunnar, William P.

AU - Dahm, Philipp

AU - Lee, Alice E.

AU - MacDonald, Roderick

AU - Shaukat, Aasma

AU - Sultan, Shahnaz

AU - Wilt, Timothy J

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Enhanced surgical recovery protocols are designed to reduce hospital length of stay and health care costs. OBJECTIVE: This study aims to systematically review and summarize evidence from randomized and controlled clinical trials comparing enhanced recovery protocols versus usual care in adults undergoing elective colorectal surgery with emphasis on recent trials, protocol components, and subgroups for surgical approach and colorectal condition. DATA SOURCES: MEDLINE from 2011 to July 2017; reference lists of existing systematic reviews and included studies were reviewed to identify all eligible trials published before 2011. STUDY SELECTION: English language trials comparing a protocol of preadmission, preoperative, intraoperative, and postoperative components with usual care in adults undergoing elective colorectal surgery were selected. INTERVENTION: The enhanced recovery protocol for colorectal surgery was investigated. MAIN OUTCOME MEASURES: Length of stay, perioperative morbidity, mortality, readmission within 30 days, and surgical site infection were the primary outcomes measured. RESULTS: Twenty-five trials of open or laparoscopic surgery for cancer or noncancer conditions were included. Enhanced recovery protocols consisted of 4 to 18 components. Few studies fully described the various components. Length of stay (mean reduction, 2.6 days; 95% CI, –3.2 to –2.0) and risk of overall perioperative morbidity (risk ratio, 0.66; 95% CI, 0.54–0.80) were lower in enhanced recovery protocol groups than in usual care groups (moderate-quality evidence). All-cause mortality (rare), readmissions, and surgical site infection rates were similar between protocol groups (low-quality evidence). In predefined subgroup analyses, findings did not vary by surgical approach (open vs laparoscopic) or colorectal condition. LIMITATIONS: Protocols varied across studies and little information was provided regarding compliance with, or implementation of, specific protocol components. CONCLUSIONS: Enhanced recovery protocols for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events. Evidence was insufficient regarding which components, or component combinations, are key to improving patient outcomes.

AB - BACKGROUND: Enhanced surgical recovery protocols are designed to reduce hospital length of stay and health care costs. OBJECTIVE: This study aims to systematically review and summarize evidence from randomized and controlled clinical trials comparing enhanced recovery protocols versus usual care in adults undergoing elective colorectal surgery with emphasis on recent trials, protocol components, and subgroups for surgical approach and colorectal condition. DATA SOURCES: MEDLINE from 2011 to July 2017; reference lists of existing systematic reviews and included studies were reviewed to identify all eligible trials published before 2011. STUDY SELECTION: English language trials comparing a protocol of preadmission, preoperative, intraoperative, and postoperative components with usual care in adults undergoing elective colorectal surgery were selected. INTERVENTION: The enhanced recovery protocol for colorectal surgery was investigated. MAIN OUTCOME MEASURES: Length of stay, perioperative morbidity, mortality, readmission within 30 days, and surgical site infection were the primary outcomes measured. RESULTS: Twenty-five trials of open or laparoscopic surgery for cancer or noncancer conditions were included. Enhanced recovery protocols consisted of 4 to 18 components. Few studies fully described the various components. Length of stay (mean reduction, 2.6 days; 95% CI, –3.2 to –2.0) and risk of overall perioperative morbidity (risk ratio, 0.66; 95% CI, 0.54–0.80) were lower in enhanced recovery protocol groups than in usual care groups (moderate-quality evidence). All-cause mortality (rare), readmissions, and surgical site infection rates were similar between protocol groups (low-quality evidence). In predefined subgroup analyses, findings did not vary by surgical approach (open vs laparoscopic) or colorectal condition. LIMITATIONS: Protocols varied across studies and little information was provided regarding compliance with, or implementation of, specific protocol components. CONCLUSIONS: Enhanced recovery protocols for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events. Evidence was insufficient regarding which components, or component combinations, are key to improving patient outcomes.

KW - Colorectal surgery

KW - Enhanced recovery

KW - Patient outcomes

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85052337695&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052337695&partnerID=8YFLogxK

U2 - 10.1097/DCR.0000000000001160

DO - 10.1097/DCR.0000000000001160

M3 - Article

VL - 61

SP - 1108

EP - 1118

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

IS - 9

ER -