Studies that evaluated the effectiveness of enhanced recovery programmes in hepatobiliary and pancreatic surgery were eligible for inclusion. Studies had to include a sufficient description of the multimodal clinical enhanced recovery programme. The primary outcome of interest was length of postoperative hospital stay. Secondary outcomes included morbidity, mortality and readmission rate.
Enhanced recovery programme protocols varied between studies but all described a multimodal clinical pathway incorporating patient education, regional anaesthesia, optimal pain relief, judicious use of surgical drains, early mobilisation and early introduction of oral liquids postoperatively. More than half of the studies conducted surgery of the liver; the rest conducted surgery of the pancreas. Surgery type varied between studies. Studies were published from 2007 to 2011.
The authors did not state how many reviewers selected studies for inclusion.