Enhanced recovery programmes in hepatobiliary and pancreatic surgery: a systematic review

INTRODUCTION The terms 'enhanced recovery after surgery', 'enhanced recovery programme' (ERR) and 'fast track surgery' refer to multimodal strategies aiming to streamline pen-operative care pathways, to maximise effectiveness and minimise costs. While the results of ERR in colorectal surgery are well reported, there have been no reviews examining if these concepts could be applied safely to hepatopancreatobiliary (HPB) surgery. The aim of this systematic review was to appraise the current evidence for ERP in HPB surgery. METHODS A MEDLINE (R) literature search was undertaken using the keywords 'enhanced recovery', 'fast-track', 'pen-operative', 'surgery', 'pancreas' and 'liver' and their derivatives such as 'pancreatic' or 'hepatic'. The primary endpoint was length of postoperative hospital stay. Secondary endpoints were morbidity, mortality and readmission rate. RESULTS Ten articles were retrieved describing an ERP. ERP protocols varied slightly between studies. A reduction in length of stay was a consistent finding following the incorporation of ERR when compared with historical controls. This was not at the expense of increased rates of readmission, morbidity or mortality in any study. CONCLUSIONS The introduction of an ERR in HPB surgery appears safe and feasible. Currently, many of the principles of the multimodal pathway are derived from the colorectal ERR and distinct differences exist, which may impede its implementation in HPB surgery.