Evidence map›Paper›PMID 41553734›Full record

ArticleBJS open2025

Enhanced recovery after surgery compliance and outcomes in an international multisurgical cohort.

Gregg Nelson, Abby Thomas, Steven P Bisch, Hans D de Boer, Bareld B Pultrum, Henriëtte Smid-Nanninga, Didier Roulin, Valerie Addor, Martin Hubner, Khara Sauro

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BJS open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Gregg NelsonDepartment of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.ORCID 0000-0002-8177-1098
Abby ThomasDepartments of Surgery, Community Health Sciences, Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Steven P BischDepartment of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Hans D de BoerDepartment of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands.
Bareld B PultrumDepartment of Surgery, Martini General Hospital Groningen, Groningen, the Netherlands.
Henriëtte Smid-NanningaMartini General Hospital Groningen, Groningen, the Netherlands.
Didier RoulinDepartment of Visceral Surgery, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.ORCID 0000-0003-1927-993X
Valerie AddorDepartment of Visceral Surgery, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.ORCID 0000-0003-2859-3971
Martin HubnerDepartment of Visceral Surgery, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
Khara SauroDepartments of Surgery, Community Health Sciences, Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Funding

CIHR 183842
6 · The paper itself

Abstract

backgroundEnhanced recovery after surgery is associated with improved clinical outcomes and cost savings. Comparisons between studies and settings are challenging owing to variable data collection and definitions. The objective of this study was to explore variation in compliance with enhanced recovery after surgery and outcomes across surgery types and countries using a standardized database.

methodsThis international retrospective cohort study included adult patients who underwent surgical procedures (colorectal, gynaecological, pancreatic, hepatic, breast reconstruction, head and neck, urological, pulmonary), treated with enhanced recovery after surgery recorded in a standardized database between January 2017 and September 2021. The primary outcomes, length of hospital stay and complications, and the exposure variable, compliance with enhanced recovery after surgery, were captured from the standardized database. Patient demographic characteristics and surgical complexity were abstracted and considered as co-variates. Negative binomial and logistic regression analyses were used to model outcomes as a function of enhanced recovery after surgery compliance score.

resultsThe cohort included 12 134 patients (from Canada, the Netherlands, and Switzerland) who had median age of 63 years and underwent colorectal (59%) or gynaecological (19%) surgery. The median compliance with enhanced recovery after surgery differed by country (Canada 78.6%, the Netherlands 67.7%, Switzerland 80.0%). Each 1-unit increase in enhanced recovery after surgery compliance score corresponded to reduced length of hospital stay across all operations, by 0.94 (95% confidence interval (c.i.) 0.85 to 1.04) days in Canada, 1.03 (0.85 to 1.20) days in the Netherlands, and 1.55 (1.12 to 1.97) days in Switzerland. Each 1-unit increase in enhanced recovery after surgery compliance score corresponded to a 29 (95% c.i. 25 to 33)% reduction in odds of experiencing a severe complication across all operations in Canada, a 22 (14 to 31)% reduction in the Netherlands, and a 5 (2 to 8)% reduction in Switzerland.

conclusionUsing a standardized database, this study confirmed that enhanced recovery after surgery compliance is associated with reduced length of hospital stay and complications in an international multisurgical cohort.

Indexed as

Enhanced Recovery After SurgeryPostoperative ComplicationsAdultAgedCanadaFemaleHumansLength of StayMaleMiddle AgedNetherlandsRetrospective StudiesSwitzerland

Identifiers

PMID41553734
PMCPMC12814877

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.