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Enhanced recovery strategies in colorectal surgery: is the compliance with the whole program required to achieve the target?

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Abstract

Purpose

The complexity of “fast track” (FT) surgery might decrease its applicability in daily practice and extensive diffusion. The aim of this study was to understand if the positive effect of FT on the outcome might be affected by the number, type, level of evidence of the components, or their possible combinations.

Methods

We performed a Medline, Embase, Pubmed, and Cochrane Library literature search of randomized and non-randomized trials comparing FT to conventional care (CC) in elective colorectal operations. By a meta-analytic approach, the effect of FT was estimated by the risk ratio (RR) with a 95 % confidence interval (CI) for the risk of post-operative complications.

Results

The analysis included 53 studies (36 non-RCTs with and 17 RCTs), with 4,100 patients in the FT group and 4,424 patients in the CC group for a total of 8,524 patients. Fifty-six different item combinations were observed. The median rate of strategy implementation was 50 %. The positive effect of FT over CC was observed regardless the number (<10 vs. ≥10) of strategies used (RR = 0.80; 95 % CI 0.66–0.98 and RR = 0.75; 95 % CI 0.65–0.87, respectively), the application of items with strong vs. low level evidence (RR = 0.78; 95 % CI 0.67–0.90 and RR = 0.76; 95 % CI 0.63–0.92, respectively), or the frequency (≥80 vs. <80 %) of items implemented (RR = 0.80; 95 % CI 0.69–0.93 and RR = 0.73; 95 % CI 0.61–0.87, respectively).

Conclusion

The positive effects of FT seem to be achieved regardless the multiplicity and variance of item grouping.

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Authors and Affiliations

  1. Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy

    Luca Gianotti, Simone Beretta & Margherita Luperto

  2. Centre of Biostatistics for Clinical Epidemiology, Department of Health Sciences, Milano-Bicocca University, Monza, Italy

    Davide Bernasconi & Maria Grazia Valsecchi

  3. Department of Surgery, San Raffaele University, Milan, Italy

    Marco Braga

  4. Department of Surgery, San Gerardo Hospital (4° piano B), Via Pergolesi 33, 20052, Monza, Italy

    Luca Gianotti

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  1. Luca Gianotti
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Gianotti, L., Beretta, S., Luperto, M. et al. Enhanced recovery strategies in colorectal surgery: is the compliance with the whole program required to achieve the target?. Int J Colorectal Dis 29, 329–341 (2014). https://doi.org/10.1007/s00384-013-1802-x

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