Randomized clinical trial on enhanced recovery versus standard care following open liver resection Enhanced recovery after liver surgery. Enhanced recovery in major colorectal surgery: safety and efficacy in an unselected surgical population at a UK district general hospital. Cost-effectiveness of Enhanced Recovery Versus Conventional Perioperative Management for Colorectal Surgery Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial Enhanced Recovery Program following Colorectal Resection in the Elderly Patient Anti-inflammatory Effects of Enhanced Recovery Programs on Early-Stage Colorectal Cancer Surgery The influence of an Enhanced Recovery Programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer Enhanced Recovery After Surgery Protocols Are Valuable in Pancreas Surgery Patients. [Application of the protocol of enhanced recovery after surgery in colorectal surgery]. Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. Enhanced Recovery After Surgery (ERAS) Program Attenuates Stress and Accelerates Recovery in Patients After Radical Resection for Colorectal Cancer: A Prospective Randomized Controlled Trial A mobile device application (app) to improve adherence to an enhanced recovery program for colorectal surgery: a randomized controlled trial An enhanced recovery pathway decreases duration of stay after esophagectomy. Adherence to Enhanced Recovery after Surgery Protocols across a High-Volume Gastrointestinal Surgical Service Ensuring Early Mobilization Within an Enhanced Recovery Program for Colorectal Surgery: A Randomized Controlled Trial An Enhanced-Recovery Protocol Improves Outcome After Colorectal Resection Already During the First Year: A Single-Center Experience in 168 Consecutive Patients
Enhanced recovery programmes ( ERPs ) have been shown to reduce length of hospital stay ( LOS ) and complications in colorectal surgery . Whether ERPs have the same benefits in open liver resection surgery is unclear , and r and omized clinical trials are lacking INTRODUCTION In a majority of cases , enhanced recovery after surgery program ( ERP ) leads to a reduced rate of postoperative complications and shortened hospital stays following digestive surgery . The program 's preoperative , perioperative and postoperative measures are implemented by the members of a motivated multidisciplinary team . Having shown its merits in digestive surgery , ERP would be particularly useful in liver surgery due to the elevated rates of morbidity and mortality this type of operation continues to entail . The objective of this review was to evaluate the efficacy of ERP  in liver surgery . METHOD This is a systematic narrative review of the literature on the efficacy of ERP  in liver surgery by laparotomy or laparoscopy . RESULTS Notwithst and ing a number of studies ( n=30 : 5 r and omized trials , 14 cohort studies and 11 meta-analyses ) less sizable than with regard to digestive surgery in general and colorectal surgery in particular , analysis of the literature confirms that in liver surgery , ERP is associated with an overall decrease in complications by 30 to 60 % , but without improvement in the rates of hospital readmission and postoperative mortality . All of the studies report a reduction in average length of stay ( ALOS ) by 2.3 days and in functional recovery , a more objective indicator than ALOS , by 2.5 days . As of now , the economic impact of the ERP programs in liver surgery is neither positive nor negative , the above-mentioned savings being counterbalanced by heightened costs for material and equipment . Laparoscopic surgery is independently associated with better outcomes in terms of complications , functional recovery and ALOS ; that is why it is important to incorporate this surgical approach in ERP as often as possible . Given a lack of robust evidence , Prehabilitation , which is a preoperative optimization process leading to improved functional reserve , has yet to be assigned a place in ERP programs pertaining to liver surgery . Possible roadblocks to application of an ERP program can be overcome through coordination by a team leader , a motivated multidisciplinary team , training courses and dedicated teaching sessions . CONCLUSION ERP is a care improvement process that has a major play to play in organization of liver surgery , and its large-scale application is to be recommended BACKGROUND Enhanced Recovery Programmes ( ERPs ) have been shown to benefit recovery following major surgery in selected centres and patient groups , but their wider applicability requires continued evaluation . The aims of this study were to assess the outcomes of the first 400 consecutive , non-selected patients , undergoing major elective colorectal surgery within an Enhanced Recovery programme at a UK District General hospital and to examine the effects of patient risk factors and operative approach on outcomes . METHODS Since September 2005 all patients undergoing major elective colon and rectal surgery at our hospital have been treated within an ERP and their data recorded prospect ively on a data base . Safety and efficacy outcomes for the first 400 patients were compared using SPSS v14.0 with both a retrospective , pre-ERP group ; and according to patient risk factors and operative approaches . RESULTS Median length of stays ( LOS ) reduced from 9 days ( IQR 7 - 11 ) to 6 days ( IQR 5 - 10 ) after introduction of the ERP ( p < 0.001 ) . No statistically significant differences in LOS were observed between elderly ( ≥80 years ) and younger patients or between different BMI groups . American Society of Anesthesiologists ( ASA ) grade 3 patients demonstrated significantly longer median LOS than those with ASA grade s 1 and 2 . Patients undergoing laparoscopic surgery  had median LOS of 6 days ( IQR 4 - 8 ) compared to 7 days ( IQR 5 - 10 ) for open procedures ( p < 0.001 ) . No differences in morbidity or mortality were observed between the groups . CONCLUSIONS Unselected application of an ERP in our unit has been associated with reductions in post-operative LOS . The ERP was safe and effective when applied to all our study patients independent of age and BMI . Despite LOS being longer in ASA grade 3 patients , application of the ERP to this higher risk group was not associated with significantly increased morbidity or mortality . Laparoscopic surgery result ed in additional modest reductions in LOS compared to open surgery within the ERP Objective : To determine the cost-effectiveness of enhanced recovery pathways ( ERPs ) versus conventional care for patients undergoing elective colorectal surgery . Background : ERPs for colorectal surgery are clinical ly effective , but their cost-effectiveness is unknown . Methods : A multi-institutional prospect i ve cohort cost-effectiveness analysis was performed . Adult patients undergoing elective colorectal resection at 2 university-affiliated institutions from October 2012 to October 2013 were enrolled . One center used an ERP , whereas the other did not . Postoperative outcomes were recorded up to 60 days . Total costs were reported in 2013 Canadian dollars . Effectiveness was measured using the SF-6D , a health utility measure vali date d for postoperative recovery . Uncertainty was expressed using bootstrapped estimates ( 10,000 repetitions ) . Results : A total of 180 patients were included  ( conventional care : n = 95 ; ERP : n = 95 ) . There were no differences in patient characteristics except for a higher proportion of laparoscopy in the ERP group . Mean length of stay was shorter in the ERP group ( 6.5 vs 9.8 days ; P = 0.017 ) , but there were no differences in complications or readmissions . Patients in the ERP group returned to work quicker and had less caregiver burden . There was no difference in quality of life between the 2 groups . The cost of the ERP program was $ 153 per patient . Overall societal costs were lower in the ERP group ( mean difference = −2985 ; 95 % confidence interval , −5753 to −373 ) . The ERP had a greater than 99 % probability of cost-effectiveness . The results were insensitive to a range of assumptions and subgroups . Conclusions : Enhanced recovery is cost-effective compared with conventional perioperative management for elective colorectal resection The aim of this r and omized clinical trial was to compare patients treated using a multimodal approach [ enhanced recovery after surgery ( ERAS ) ]  , with a special focus on counselling , to patients treated in a st and ard conventional care pathway , who underwent elective colorectal resection Background The enhanced recovery program ( ERP ) aims to reduce the metabolic response to surgery , hastening recovery and shortening hospital stay . Concerns exist regarding morbidity and hospital stay in elderly patients . The present study aim ed to compare the outcomes and compliance of elderly patients managed by an ERP protocol with a younger group . Methods A review was performed of a prospect i ve data base of patients undergoing colorectal resection managed under the ERP protocol between 2005 and 2010 . Patients were grouped into < 80 years and ≥80 years , and perioperative data were collated . The postoperative outcomes were compared with the goals set out by the ERP protocol . Results A total of 688 patients were included , 558 were < 80 years ( median : 66 years ; range : 17–79 years ) and 130 were ≥80 years ( median : 83 years ; range : 80–95 years ) . Some 96 % of operations were planned laparoscopically . Median total length of hospital stay was 6 days ( range : 1–108 days ) for the < 80 year group and 8 days ( range : 1–167 days ; P 0.363 ) for the elderly group , with a 30 day readmission rate of 8.6 % for the population and no significant differences between groups . The 30 day mortality was 5 % , with a significant difference between the two groups ( P < 0.0001 ) . Differences in protocol adherence were identified in the discontinuation of intravenous fluids , catheter removal , and early mobilization . Conclusions An enhanced recovery program is feasible for colorectal surgery patients ≥80 years of age , with similar compliance as the younger group to some aspects of the protocol and an acceptable readmission rate . Attention to improving compliance in the postoperative phase is necessary , particularly in such high-risk patients , as such improvement may reduce the morbidity and mortality Background Postoperative ileus ( POI ) is observed in 20–30 % of patients undergoing colorectal cancer surgery , despite enhanced recovery programs ( ERPs ) . Cyclooxygenase (COX)-2 is identified as a key enzyme in POI , but other arachidonic acid pathway enzymes have received little attention despite their potential as selective targets to prevent POI . The objectives were to compare the expression of arachidonic acid metabolism ( AAM ) enzymes ( 1 ) between patients who underwent colorectal cancer surgery and followed an ERP or not ( NERP ) , ( 2 ) and between ERP patients who experimented POI or not and ( 3 ) to determine the ability of antagonists of these pathways to modulate contractile activity of colonic muscle . Methods This was a translational study . Main outcome measures were gastrointestinal motility recovery data , mRNA expressions of key enzymes involved in AAM ( RT-qPCR ) and ex vivo motility values of the circular colon muscle . Twenty-eight prospect ively included ERP patients were compared to eleven retrospectively included NERP patients that underwent colorectal cancer surgery . Results ERP  reduced colonic mucosal COX-2 , microsomal prostagl and in E synthase ( mPGES1 ) and hematopoietic prostagl and in D synthase ( HPGDS ) mRNA expression . mPGES1 and HPGDS mRNA expression were significantly associated with ERP compliance ( respectively , r2 = 0.25 , p = 0.002 and r2 = 0.6 , p < 0.001 ) . In muscularis propria , HPGDS mRNA expression was correlated with GI motility recovery ( p = 0.002 ) . The pharmacological inhibition of mPGES1 increased spontaneous ex vivo contractile activity in circular muscle ( p = 0.03 ) . Conclusion The effects of ERP on GI recovery are correlated with the compliance of ERP and could be mediated at least in part by mPGES1 , HPGDS and COX-2 . Furthermore , mPGES1 shows promise as a therapeutic target to further reduce POI duration among ERP patients Objective Optimizing peri‐operative care using an enhanced recovery programme improves short‐term outcomes following colonic resection . This study compared a prospect i ve group of patients undergoing resection of colorectal cancer within an enhanced recovery programme , with a prospect ively studied historic cohort receiving conventional care BACKGROUND There is increasing interest in implementing comprehensive perioperative protocol s , including preoperative optimization and education , perioperative goal -directed fluid management , and postoperative fast tracking , to enhance recovery after surgery . Data on the outcomes of these protocol s in pancreatic surgery , however , are limited . STUDY DESIGN A retrospective review of a prospect ively maintained pancreas surgery data base at a single institution from August 2012 to April 2015 was undertaken . An enhanced recovery protocol was initiated in October 2014 , and patients were divided into groups according to pre protocol or post protocol implementation . Preoperative , intraoperative , and postoperative data were tabulated . Statistical analysis was performed with Student 's t-test and Fisher 's exact tests , as well as e quality of variances where appropriate , using SAS System software ( SAS Institute ) . RESULTS Three hundred and seventy-eight patients ( 181 men , mean age 54 years , BMI 28 kg/m(2 ) ) underwent elective pancreatic surgery during the study period , 297 patients pre protocol and 81 post protocol . There were no significant differences in preoperative or intraoperative characteristics . Mean postoperative length of stay was significantly lower in the Enhanced Recovery After Surgery group ( 7.4 vs 9.2 days ; p < 0.0001 ) . Hospital costs were similarly lower in the Enhanced Recovery After Surgery group ( $ 23,307.90 vs $ 27,387.80 ; p < 0.0001 ) . Readmission ( 29 % vs 32 % ) and pancreatic fistula ( 26 % vs 28 % ) rates were similar between groups . Delayed gastric emptying was lower in the Enhanced Recovery After Surgery group ( 26 % vs 13 % ; p = 0.03 ) . CONCLUSIONS Implementation of an enhanced recovery after pancreatic surgery protocol significantly decreased length of stay and hospital cost without increasing readmission or morbidity . Despite patient complexity and the potential need for individualization of care , enhanced recovery protocol s can be valuable and effective in high-risk patient population s , including pancreatic surgery patients OBJECTIVE To evaluate  enhanced recovery after surgery(ERAS ) protocol in colorectal surgery . METHODS From september 2006 to February 2007 , 74 patients with colorectal cancer were r and omly assigned to ERAS group and control group . The stress index , nutrition and metabolism index , intraoperative index and postoperative index were evaluated . RESULTS Six patients were excluded , 3 in ERAS group ( 2 cases received hepatectomy concomitantly and 1 case received partial ileum resection ) , and 3 in control group ( 1 case received hepatectomy  and 1 case received colorectomy concomitantly , another presented asthma paroxysm ) . So there were 34 cases in ERAS group and 34 cases in control , with no statistical differences in sex , age , BMI index and operation types . Deviation of HOMA-IR index of ERAS was lower than the control ( P>0.05 ) , the same as plasma cortisol at the 1st day after operation ( P<0.05 ) , but plasma glucagons in the operation of ERAS group was higher than that of control ( P<0.05 ) . Plasma glucose 1st day after operation of ERAS group was lower than control ( P<0.05 ) , while plasma triglyceride intraoperation , at 1st day , 2nd day after operation of ERAS was higher than control ( P<0.05 ) . Nitrogen negative balance of ERAS group was higher than control at 2nd day after surgery , but is lower intraoperation and at 6th day after operation ( P<0.05 ) . The time of exhaust gas and stool , time to eat fluidity and semi-fluidity , out-of-bed time and exercise time per-day , residual time and complication rate in ERAS group were better than those of control ( P<0.05 ) . Post-operative expenses of ERAS was lower than that of control ( P<0.05 ) . CONCLUSION ERAS can decrease surgical stress , increase functional recovery and reduce complication rate BACKGROUND AND AIMS The Enhanced Recovery after Surgery ( ERAS ) program has been proposed as a postoperative recovery-enhancing strategy . We frequently apply the Modified-ERAS program following oesophagectomy . This study aims to eluci date the impact of goal -directed fluid therapy ( GDT ) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy . METHODS This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre , Japan . Patients who underwent elective oesophagectomy for oesophageal cancer were recruited . Group H ( retrospectively collected ) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program , while Group S prospect ively received management consisting of GDT and the M-ERAS program . The primary endpoint was the speed of gastrointestinal functional recovery , while secondary endpoints were the level of postoperative mobilisation , incidence of complications , postoperative length of hospital stay ( LOS ) , and nutritional status after discharge . RESULTS The proportion of patients who completely egested Gastrografin by postoperative day 4 , the level of postoperative mobilisation , and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H ( P = 0.034 , P = 0.0197 , and P < 0.0001 , respectively ) . No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups . The serum albumin levels at 6 months after discharge was higher in Group S than in Group H ( P = 0.0002 ) . CONCLUSIONS The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation , as well as postoperative nutritional status and protein synthesis . The program did not affect either postoperative LOS or the incidence of complications . TRIAL REGISTRATION UMIN registration number : UMIN000013705 , https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999 Background The aim of this trial was to compare the Enhanced Recovery After Surgery ( ERAS ) program with conventional perioperative management in patients who underwent radical resection for colorectal cancer . Methods A combination of evidence -based and consensus methodology was used to develop the ERAS protocol . Five hundred ninety-seven consecutive patients who underwent elective colorectal resection were r and omized to either the ERAS ( n = 299 ) or the  control group ( n = 298 ) . Outcomes relating to nutrition and metabolism index , stress index , and recovery index were measured and recorded . Results Demographic and operative data were similar between the two groups . Patients in the ERAS group showed improved nutritional status when compared with those of the control group . On postoperative day ( POD ) 1 , the HOMA-IR ( insulin resistance index ) of the ERAS group was lower than that of the control group ( p < 0.001 ) . The cortisol level of the control group was elevated on both POD 1 ( p = 0.007 ) and POD 5 ( p = 0.002 ) compared to the preoperative level . However , the cortisol level of the ERAS group was not increased until POD 5 ( p = 0.001 ) . Reduced levels of TNF-α , IL-1β , IL-6 , and IFN-γ in the ERAS group indicated less postoperative stress responses . In addition , ERAS was associated with accelerated recovery of gastrointestinal function . The postoperative length of stay ( p < 0.001 ) and expense ( p < 0.001 ) for the ERAS group were reduced in comparison to the controls . Twenty-eight cases in the control group and twenty-nine in the ERAS group suffered complications , which was not significantly different . Conclusion The ERAS protocol attenuates the surgical stress response and accelerates postoperative recovery without compromising patient safety Background Increased adherence with enhanced recovery pathways ( ERP ) is associated with improved outcomes . However , adherence to postoperative elements that rely on patient participation remains suboptimal . Mobile device apps may improve delivery of health education material and have the potential to foster behavior change and improve patient compliance . The objective of this study was to estimate the extent to which a novel mobile device app affects adherence to an ERP for colorectal surgery in comparison to st and ard written education . Methods This was a superiority , parallel-group , assessor-blind , sham-controlled r and omized trial involving 97 patients undergoing colorectal resection . Participants were r and omly assigned with a 1:1 ratio into one of two groups : ( 1 ) iPad including a novel mobile device app for postoperative education and self- assessment of recovery , or ( 2 ) iPad without the app . The primary outcome measure was mean adherence ( % ) to a bundle of five postoperative ERP elements requiring patient participation : mobilization , gastrointestinal motility stimulation , breathing exercises , and consumption of oral liquids and nutritional drinks . Results In the intervention group , app usage was high ( 94 % completed surveys on POD0 , 82 % on POD1 , 72 % on POD2 ) . Mean overall adherence to the bundle on the two first postoperative days was similar between groups : 59 % ( 95 % CI 52–66 % ) in the intervention group and 62 % ( 95 % CI 56–68 % ) in the control group [ Adjusted mean difference 2.4 % ( 95 % CI − 5 to 10 % ) p = 0.53 ] . Conclusions In this r and omized trial , access to a mobile health application did not improve adherence to a well-established enhanced recovery pathway in colorectal surgery patients , when compared to st and ard written patient education . Future research should evaluate the impact of applications integrating novel behavioral change techniques , particularly in context s where adherence is low PURPOSE Enhanced recovery pathways ( ERP ) decrease morbidity and duration of stay after colorectal surgery . There is little information about their role in complex procedures , such as esophagectomy . The purpose of this study was to determine the impact of an ERP on duration of stay , complications , and readmissions after esophagectomy . METHODS Patients undergoing esophagectomy for cancer or high- grade dysplasia from June 2009 to December 2011 were identified from a prospect ively maintained data base . Beginning in June 2010 , all patients were enrolled in a 7-day multidisciplinary ERP including written patient education with daily treatment plan , indications for intensive care admission , early structured mobilization , and diet and drain management . Short-term ( 30-day ) outcomes were compared for patients undergoing esophagectomy pre- and post-pathway . Data are expressed as median values [ interquartile range ] . RESULTS We identified 106 patients ; 47 underwent esophagectomy before ERP implementation and 59 after . Patients were similar with respect to age , gender , diagnosis , and operative time .  Hospital stay was shorter in the ERP group ( 8 [ 7 - 17 ] vs 10 [ 9 - 17 ] days ; P = .01 ) . There were no differences in rates of complications ( 59 % vs 62 % ) or readmissions ( 6 % vs 5 % ) . CONCLUSION Implementation of a multidisciplinary ERP for esophagectomy was associated with decreased duration of stay , without an increase in complications or readmissions Background and Aims : Enhanced recovery after surgery ( ERAS ) has been shown to improve outcomes for patients following gastrointestinal surgery . Data on protocol adherence and how this impacts on outcome are limited . This study examines how protocol adherence changes over time and determines how this impacts on outcome across a large-volume gastrointestinal surgical service . Material s and Methods : A prospect i ve review of patients eligible for colorectal , liver and oesophagogastric ERAS over two 3-month periods in 2010 and 2011 was performed . End points included : length of stay ( LOS ) , overall protocol adherence , individual modality adherence , reason for pathway deviation and patient outcomes . Results : 172 patients ( 110 colorectal , 31 liver and 31 oesophagogastric ) were evaluated . For each sub-speciality , the introduction of ERAS led to significant reductions in LOS that were sustained for the duration of the study . Adherence was achieved across 60 % ( colorectal ) , 75 % ( liver ) and 88 % ( oesophagogastric ) of individual pathway modalities . The major causes of pathway deviation were : post-operative nausea and vomiting ( colorectal ) , pain ( liver ) and pulmonary complications ( oesophagogastric ) . Conclusions : Large-scale implementation of ERAS at a high-volume centre is feasible and offers many of the benefits demonstrated in controlled trials , but adherence may diminish over time Objective : To estimate the extent to which the addition of staff-directed facilitation of early mobilization to an Enhanced Recovery Program ( ERP ) impacts recovery after colorectal surgery , compared with usual care . Summary Background Data : Early mobilization is considered an important component of ERPs but , despite guidelines recommendations , adherence remains quite low . The value of dedicating specific re sources ( eg , staff time ) to increase early mobilization is unknown . Methods : This r and omized trial involved 99 colorectal surgery patients in an established ERP ( median age 63 , 57 % male , 80 % laparoscopic ) r and omized 1:1 to usual care  ( including preoperative education about early mobilization with postoperative daily targets ) or facilitated mobilization [ staff dedicated to assist transfers and walking from postoperative days ( PODs ) 0–3 ] . Primary outcome was the proportion of patients returning to preoperative functional walking capacity ( 6-min walk test ) at 4 weeks after surgery . We also explored the association of the intervention with in-hospital mobilization , time to achieve discharge criteria , time to recover gastrointestinal function , 30-day comprehensive complication index , and patient-reported outcome measures . Results : In the facilitated mobilization group , adherence to mobilization targets was greater on POD0 [ OR 4.7 ( 95 % CI 1.8–11.9 ) ] , POD1 [ OR 6.5 ( 95 % CI 2.3–18.3 ) ] , and POD2 [ OR 3.7 ( 95 % CI 1.2–11.3 ) ] . Step count was at least 2-fold greater on POD1 [ mean difference 843.3 steps ( 95 % CI 219.5–1467.1 ) ] and POD2 [ mean difference 1099.4 steps ( 95 % CI 282.7–1916.1 ) ] There was no between-group difference in recovery of walking capacity at 4 weeks after surgery [ OR 0.77 ( 95 % CI 0.30–1.97 ) ] . Other outcome measures were also not different between groups . Conclusions : In an ERP for colorectal surgery , staff-directed facilitation of early mobilization increased out-of-bed activities during hospital stay but did not improve outcomes . This study does not support the value of allocating additional re sources to ensure early mobilization in ERPs . Trial Registration : Clinical Trials.gov Identifier : PURPOSE : This study was design ed to investigate the clinical outcome and recovery before and immediately after implementation of the enhanced recovery after surgery enhanced recovery after surgery protocol in colonic and rectal resection . METHODS : One hundred and sixty-eight consecutive patients in a single center underwent colorectal surgery before ( traditional , n = 69 ) and immediately after implementing enhanced recovery after surgery ( n = 99 ) . Rectal surgery was performed in 77 patients . Postoperative food and fluid intake , mobilization , physiologic function , and clinical outcome were measured prospect ively . RESULTS : Resumption of oral diet was achieved on postoperative day postoperative day 1 in the enhanced recovery after surgery group . In the enhanced recovery after surgery group , mobilization more than 6 hours daily was achieved on postoperative day 2 to 3 and passage of stool occurred on postoperative day 2 vs. postoperative day 5 in the traditional group ( P < 0.0001 ) . Muscle strength and lung function were less reduced in the enhanced recovery after surgery group ( P < 0.05 ) . Median hospital stay was reduced by 2 days ( P < 0.01 ) . Readmission rates increased ( 4 percent vs. 15 percent , P < 0.01 ) but total hospital stay was still lower in the enhanced recovery after surgery group ( P < 0.01 ) . After colonic resection , postoperative complications decreased in enhanced recovery after surgery ( 37 percent vs. 18 percent , P < 0.05 ) , whereas no change was found after rectal resection . CONCLUSION : Immediately after implementing enhanced recovery after surgery , recovery was improved and length of hospital stay was reduced . Notably , postoperative morbidity decreased only in patients undergoing colonic resection
The present systematic review suggests that ERPs in colorectal and pancreas surgery are associated with cost savings compared to conventional perioperative management .
Enhanced recovery programs ( ERPs ) have been shown to improve postoperative outcomes after abdominal surgery .
This study aim ed to review the current literature to assess if ERPs in colorectal , pancreas , and liver surgery induce cost savings .