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Surgical Endoscopy

, Volume 31, Issue 5, pp 2050–2071 | Cite as

Factors predicting outcome from enhanced recovery programmes in laparoscopic colorectal surgery: a systematic review

  • David E. Messenger
  • Nathan J. Curtis
  • Adam Jones
  • Emma L. Jones
  • Neil J. Smart
  • Nader K. FrancisEmail author
Review

Abstract

Objective

To perform a systematic review of published literature for the factors reported to predict outcomes of enhanced recovery after surgery (ERAS) programmes following laparoscopic colorectal surgery.

Background

ERAS programmes and the use of laparoscopy have been widely adopted in colorectal surgery bringing short-term patient benefit. However, there is a minority of patients that do not benefit from these strategies and their identification is not well characterised. The factors that underpin outcomes from ERAS programmes for laparoscopic patients are not understood.

Methods

A systematic search of the MEDLINE, Embase and Cochrane databases was conducted to identify suitable articles published between 2000 and 2015. The search strategy captured terms for ERAS, colorectal resection, prediction and outcome measures.

Results

Thirty-four studies containing 10,861 laparoscopic resections were included. Thirty-one (91 %) studies were confined to elective cases. Predictive analysis of outcome was most frequently based on length of stay (LOS), morbidity and readmission which were the main outcome measures of 29 (85 %), 26 (76 %) and 18 (53 %) of the included studies, respectively. Forty-seven percentage of included studies investigated the impact of ERAS programme compliance on these outcomes. Reduced protocol compliance was the most frequently identified modifiable predictive factor for adverse LOS, morbidity and readmission.

Conclusion

Protocol compliance is the most frequently reported predictive factor for outcomes of ERAS programmes following laparoscopic colorectal resection. Reduced compliance increases LOS, morbidity and readmission to hospital. The impact of compliance with individual ERAS protocol elements is insufficiently studied, and the lack of a standardised framework for evaluating ERAS programmes makes it difficult to draw definite conclusions about which factors exert the greatest impact on outcome after laparoscopic colorectal resection.

Keywords

Enhanced recovery ERAS Outcome Prediction Colorectal 

Notes

Compliance with ethical standards

Disclosures

David E. Messenger, Nathan J. Curtis, Adam Jones, Emma L. Jones, Neil J. Smart and Nader K. Francis have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • David E. Messenger
    • 1
  • Nathan J. Curtis
    • 2
  • Adam Jones
    • 2
  • Emma L. Jones
    • 3
  • Neil J. Smart
    • 4
  • Nader K. Francis
    • 2
    Email author
  1. 1.Colorectal Surgical UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
  2. 2.Department of General SurgeryYeovil District Hospital NHS Foundation TrustHigher Kingston, YeovilUK
  3. 3.Department of Health SciencesUniversity of LeicesterLeicesterUK
  4. 4.Department of General SurgeryRoyal Devon and Exeter NHS Foundation TrustExeterUK

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