Recommendation ID

What is the clinical and cost effectiveness of enhanced recovery programmes for adults having major emergency surgery?

Any explanatory notes
(if applicable)

Why the committee made the recommendations

There was a large body of evidence showing that hospital stays are shorter, postoperative complications less frequent and overall costs lower when people having elective major or complex surgery follow an enhanced recovery programme (ERP).

The committee agreed that, for optimum effectiveness, an ERP should span the preoperative, intraoperative and postoperative stages, so recommended that components covering all 3 stages be included. They acknowledged that the specific components of an ERP depend on the type of surgery so did not make recommendations detailing the particulars of these components.

There is no evidence on the effectiveness of ERPs in emergency surgery, but the committee thought they might be beneficial and made a recommendation for research on enhanced recovery programmes.

How the recommendations might affect practice

According to the Perioperative Quality Improvement Programme (PQIP) 2017/2018 annual report, 61% of patients enrolled in the PQIP were following an ERP. The report noted that the use of ERPs varies across specialties and hospitals. To implement this recommendation, specialties and hospitals that do not currently provide an ERP covering all 3 stages of perioperative care for patients having major or complex elective surgery will need to restructure their surgical care. This might have an initial resource impact, although some features of an ERP, such as early mobilisation and early intake of food and fluids, are current practice in many hospitals. Introducing an ERP can be expected to reduce the length of hospital stays and the incidence of complications, thereby reducing overall costs.

Source guidance details

Comes from guidance
Perioperative care in adults
Date issued
August 2020

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 01/08/2020