A new Cochrane Review from February 2016, which was prepared as part of a programme of reviews funded by the National Institute for Health Research in England investigates the evidence on enhanced recovery protocols for major upper gastrointestinal surgery. Kurinchi Gurusamy, from the Department of Surgery in UCL Medical School in London tells us what they found.
John: A new Cochrane Review from February 2016, which was prepared as part of a programme of review funded by the National Institute for Health Research in England investigates the evidence on enhanced recovery protocols for major upper gastrointestinal surgery. Kurinchi Gurusamy, from the Department of Surgery in UCL Medical School in London tells us what they found.
Kurinchi: The 'enhanced recovery protocol' or 'fast-track surgery' or 'fast-track rehabilitation' incorporates one or more of the following elements: patient education before surgery, pain relief during and after surgery, early mobilisation after surgery, nutritional supplements, and oral or nasogastric feeding rather than parenteral nutrition. The intention is to decrease the stress that the patient is under from their surgery, with the aim of helping them to recover more quickly. This might then lead to earlier discharge from hospital and a faster return to normal activities. We’ve evaluated the benefits and harms of using some types of enhanced recovery protocol for people undergoing major upper gastrointestinal surgeries, including operations on the liver and pancreas by considering the randomised trials reported up to March 2015 and we have found potentially quite important benefits.
Ten studies met the inclusion criteria for our reviews, and just over a thousand participants in nine trials contributed to one or more outcomes for the review. The only health problem for most of the participants in the trials was the condition that meant they needed surgery. Our analyses show that people undergoing surgery using enhanced recovery protocols had fewer minor complications, were in hospital for an average of two days fewer, and incurred costs that we standardised to about 6300 USD less than standard care. There was no evidence for a difference in short-term mortality, major complications rates, health-related quality of life and hospital readmissions between enhanced recovery protocol and standard care.
However, uncertainties remain because of the generally poor quality of the current evidence and because the trials done to date did not report all the clinically important end points. Therefore, high quality randomised trials are still needed in this field and these need to measure and report patient outcomes up to at least one year after the surgery.
John: If you would like to read more about the findings of the review, and to await future updates should those new trials be done, you can find it in the Cochrane Library. Just go to Cochrane Library dot com and search for 'enhanced recovery protocols'.