Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009-2012

J C Simpson; S R Moonesinghe; M P W Grocott; M Kuper; A McMeeking; C M Oliver; M J Galsworthy; M G Mythen; National Enhanced Recovery Partnership Advisory Board

doi:10.1093/bja/aev105

Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009-2012

Br J Anaesth. 2015 Oct;115(4):560-8. doi: 10.1093/bja/aev105. Epub 2015 Apr 29.

Authors

J C Simpson¹, S R Moonesinghe², M P W Grocott³, M Kuper⁴, A McMeeking⁵, C M Oliver², M J Galsworthy², M G Mythen⁶; National Enhanced Recovery Partnership Advisory Board

Collaborators

National Enhanced Recovery Partnership Advisory Board:
Sir Mike Richards, Keith Willett, Michael Mythen, Alan Horgan, Celia Ingham Clark, Ann Driver, Janet Williamson, Neil Betteridge, Sheila Dixon, Tracey Ellison, Kerri Jones, Martin Kuper, John McGrath, Chris Moulton, Michael Swart, Rachel Wakefield, Claire Strickland, Robin Crawford, Alan Nye, Nigel Acheson, James Kingsland, Donal O'Donoghue, Joe Dias, Wendy Lewis, Andy McMeeking, Jane Allberry, Umakanth Panchagnula, Thomas Satyadas, Gary Minto, Bill Fawcett, Donald Graham, Babu Naidu, Carol Peden, Tim Rockall, Michael Scott, Chris Tulloch, James Catton

Affiliations

¹ The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK.
² The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK.
³ The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK Anaesthesia and Critical Care Research Unit, University Hospitals Southampton; Integrative Physiology and Critical Illness Group, University of Southampton and University Hospital Southampton, University of Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK.
⁴ Homerton Hospital, Homerton Row, London, UK.
⁵ National Cancer Action Team, NHS, London, UK.
⁶ The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK [email protected].

PMID: 25926312
DOI: 10.1093/bja/aev105

Abstract

Background: The UK Department of Health Enhanced Recovery Partnership Programme collected data on 24 513 surgical patients in the UK from 2009-2012. Enhanced Recovery is an approach to major elective surgery aimed at minimizing perioperative stress for the patient. Previous studies have shown Enhanced Recovery to be associated with reduced hospital length of stay and perioperative morbidity.

Methods: In this national clinical audit, National Health Service hospitals in the UK were invited to submit patient-level data. The data regarding length of stay and compliance with each element of Enhanced Recovery protocols for colorectal, orthopaedic, urological and gynaecological surgery patients were analysed. The relationship between Enhanced Recovery protocol compliance and length of stay was measured.

Results: From 16 267 patients from 61 hospital trusts, three out of four surgical specialties showed Enhanced Recovery, compliance being weakly associated with shorter length of stay (correlation coefficients -0.18, -0.14, -0.25 in colorectal, orthopaedics and gynaecology respectively). At a cut-off of 80% compliance, good compliance was associated with two, one and three day reductions in median length of stay respectively in colorectal, orthopaedic and urological surgeries, with no saving in gynaecology.

Conclusions: This study is the largest assessment of the relationship between Enhanced Recovery protocol compliance and outcome in four surgical specialties. The data suggest that higher compliance with an Enhanced Recovery protocol has a weak association with shorter length of stay. This suggests that changes in process, resulting from highly protocolised pathways, may be as important in reducing perioperative length of stay as any individual element of Enhanced Recovery protocols in isolation.

Keywords: anesthesia; general surgery; perioperative care.

Publication types

Evaluation Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Cooperative Behavior
Elective Surgical Procedures*
Female
Guideline Adherence
Humans
Length of Stay / statistics & numerical data
Male
Medical Audit / methods
Medical Audit / statistics & numerical data*
Middle Aged
Perioperative Care / methods*
Perioperative Care / statistics & numerical data
Postoperative Complications / prevention & control*
Program Evaluation / methods
Program Evaluation / statistics & numerical data*
Recovery of Function*
United Kingdom
Young Adult

Grants and funding

Medical Research Council/United Kingdom