Perioperative Care Pathways in Low‐ and Lower‐Middle‐Income Countries: Systematic Review and Narrative Synthesis

Abstract

Background Safe and effective care for surgical patients requires high-quality perioperative care. In high-income countries (HICs), care pathways have been shown to be effective in standardizing clinical practice to optimize patient outcomes. Little is known about their use in low- and middle-income countries (LMICs) where perioperative mortality is substantially higher. Methods Systematic review and narrative synthesis to identify and describe studies in peer-reviewed journals on the implementation or evaluation of perioperative care pathways in LMICs. Searches were conducted in MEDLINE, EMBASE, CINAHL Plus, WHO Global Index, Web of Science, Scopus, Global Health and SciELO alongside citation searching. Descriptive statistics, taxonomy classifications and framework analyses were used to summarize the setting, outcome measures, implementation strategies, and facilitators and barriers to implementation. Results Twenty-seven studies were included. The majority of pathways were set in tertiary hospitals in lower-middle-income countries and were focused on elective surgery. Only six studies were assessed as high quality. Most pathways were adapted from international guidance and had been implemented in a single hospital. The most commonly reported barriers to implementation were cost of interventions and lack of available resources. Conclusions Studies from a geographically diverse set of low and lower-middle-income countries demonstrate increasing use of perioperative pathways adapted to resource-poor settings, though there is sparsity of literature from low-income countries, first-level hospitals and emergency surgery. As in HICs, addressing patient and clinician beliefs is a major challenge in improving care. Context-relevant and patient-centered research, including qualitative and implementation studies, would make a valuable contribution to existing knowledge.

Implementation of Enhanced Recovery After Surgery Protocol in a Second-level Hospital

“…Despite the importance of research in the area of perioperative care, there remains a paucity of evidence on fast-track surgery pathways in the developing world. A recent systematic review by Patel et al [25] identified twenty-seven eligible articles on perioperative care pathways conducted in Low-and Middle-Income Countries (LMIC) published since the year 2000, and only one of them (in obstetrics and gynaecology) [26] was performed in Sub-Saharan Africa. The search of the literature additionally revealed two citations.…”

Transforming Bariatric Surgery Outcomes: The Pivotal Role of Enhanced Recovery After Surgery (ERAS) Protocols in Patient-Centered Care

“…Adopting ERAS protocols marks a significant shift toward more efficient, patient-focused care, a viewpoint echoed by Patel et al [ 17 ]. Their advocacy for multimodal perioperative care strategies aligns closely with our findings, underscoring the potential of these protocols to enhance the overall surgical experience for patients.…”