Does an enhanced recovery programme add value to laparoscopic colorectal resections?

Rao, Pawan Kumar Dhruva; Howells, Sally; Haray, P. N.

doi:10.1007/s00384-015-2320-9

Cited by 12 publications

(18 citation statements)

References 11 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 73 prioritised studies (reported in 80 articles), 39 (40 articles) were conducted in the UK, 31,191,192,194,195,197,201,203,[205][206][207][208]210,212,213,215,216,218,224,226,[228][229][230][231][232][236][237][238]241,244,245,250,253,256,257,259,260,262,263,269 13 of which were RCTs. Thirty-four (41 articles) were RCTs conducted in one of 15 other countries, the most common of which were six studies from Germany, 202,217,227,240,[246][247][248][249]…”

Section: Sample Characteristicsmentioning

confidence: 99%

“…Thirty-four (41 articles) were RCTs conducted in one of 15 other countries, the most common of which were six studies from Germany, 202,217,227,240,[246][247][248][249]255 five from the Netherlands, 204,[219][220][221]265,266,268 four from Denmark 196,225,233,234,267 and four from Canada. 193,198,200,214 The remaining studies consisted of 24 uncontrolled before-and-after (UBA) trials 191,194,195,197,201,203,[206][207][208]212,216,218,228,230,232,237,238,241,245,250,253,257,262,…”

Section: Sample Characteristicsmentioning

confidence: 99%

“…233 The majority of articles (81.5%) were published from 2008 onwards, with 50 (61.7%) published since 2011. 31,191,195,197,199,[201][202][203][205][206][207][208][209]211,212,214,216,219,220,222,[225][226][227][228][229][230][235][236][237][238][239][240][241][242][243]249,250,252,253,255,[257][258][259][260][262][263][264][265]267,…”

Section: Sample Characteristicsmentioning

confidence: 99%

“…The reasons for admission, according to our broad procedural categories, were lower-limb arthroplasty (n = 25 studies 195,196,200,202,206,216,218,[221][222][223][224]230,234,237,238,241,244,245,253,254,256,261,262,267,269 ), colorectal surgery (n = 19 studies 192,198,203,204,209,211,213,214,229,231,232,235,236,239,242,243,251,252,265 ), cardiac surgery (n = 8 studies 193,208,210,215,255,…”

Section: Sample Characteristicsmentioning

confidence: 99%

“…Only two studies, 193,270 both of which were RCTs, received a global study quality rating of 'strong' using the EPHPP tool. 46 Twenty-six studies, 194,196,199,202,205,211,213,215,217,220,222,223,225,227,232,234,235,239,242,243,256,258,264,[267][268][269] of which 24 were RCTs, received a 'moderate' quality rating, and the remaining 45 studies 191,192,195,197,198,200,201,203,204,[206][207][208][209][210]212,214,216,218,221,224,…”

Section: Quality Assessmentmentioning

confidence: 99%

See 4 more Smart Citations

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

Nunns

Shaw

Briscoe

et al. 2019

Health Serv Deliv Res

View full text Add to dashboard Cite

Background Elective older adult inpatient admissions are increasingly common. Older adults are at an elevated risk of adverse events in hospital, potentially increasing with lengthier hospital stay. Hospital-led organisational strategies may optimise hospital stay for elective older adult inpatients. Objectives To evaluate the effectiveness and cost-effectiveness of hospital-led multicomponent interventions to reduce hospital stay for older adults undergoing elective hospital admissions. Data sources Seven bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database) were searched from inception to date of search (August 2017), alongside carrying out of web searches, citation searching, inspecting relevant reviews, consulting stakeholders and contacting authors. This search was duplicated, with an additional cost-filter, to identify cost-effectiveness evidence. Review methods Comparative studies were sought that evaluated the effectiveness or cost-effectiveness of relevant interventions in elective inpatients with a mean or median age of ≥ 60 years. Study selection, data extraction and quality assessment were completed independently by two reviewers. The main outcome was length of stay, but all outcomes were considered. Studies were sorted by procedure, intervention and outcome categories. Where possible, standardised mean differences or odds ratios were calculated. Meta-analysis was performed when multiple randomised controlled trials had the same intervention, treatment procedure, comparator and outcome. Findings were explored using narrative synthesis. Findings A total of 218 articles were included, with 80 articles from 73 effectiveness studies (n = 26,365 patients) prioritised for synthesis, including 34 randomised controlled trials conducted outside the UK and 39 studies from the UK, of which 12 were randomised controlled trials. Fifteen studies included cost-effectiveness data. The evidence was dominated by enhanced recovery protocols and prehabilitation, implemented to improve recovery from either colorectal surgery or lower limb arthroplasty. Six other surgical categories and four other intervention types were identified. Meta-analysis found that enhanced recovery protocols were associated with 1.5 days’ reduction in hospital stay among patients undergoing colorectal surgery (Cohen’s d = –0.51, 95% confidence interval –0.78 to –0.24; p < 0.001) and with 5 days’ reduction among those undergoing upper abdominal surgery (Cohen’s d = –1.04, 95% confidence interval –1.55 to –0.53; p < 0.001). Evidence from the UK was not pooled (owing to mixed study designs), but it echoed findings from the international literature. Length of stay usually was reduced with intervention or was no different. Other clinical outcomes also improved or were no worse with intervention. Patient-reported outcomes were not frequently reported. Cost and cost-effectiveness evidence came from 15 highly heterogeneous studies and was less conclusive. Limitations Studies were usually of moderate or weak quality. Some intervention or treatment types were under-reported or absent. The reporting of variance data often precluded secondary analysis. Conclusions Enhanced recovery and prehabilitation interventions were associated with reduced hospital stay without detriment to other clinical outcomes, particularly for patients undergoing colorectal surgery, lower limb arthroplasty or upper abdominal surgery. The impacts on patient-reported outcomes, health-care costs or additional service use are not well known. Future work Further studies evaluating of the effectiveness of new enhanced recovery pathways are not required in colorectal surgery or lower limb arthroplasty. However, the applicability of these pathways to other procedures is uncertain. Future studies should evaluate the implementation of interventions to reduce service variation, in-hospital patient-reported outcomes, impacts on health and social care service use, and longer-term patient-reported outcomes. Study registration This study is registered as PROSPERO CRD42017080637. Funding The National Institute for Health Research Health Services and Delivery Research programme.

show abstract