Quality of life and patient satisfaction with enhanced recovery protocols

Aim: The aim of this study was to systematically review the literature on the influence of enhanced recovery after surgery (ERAS) protocols and health related quality of life (HQoL) and patient satisfaction.

Method: A systematic review of the literature from January 1990 to February 2009 was undertaken. Studies were included if they compared HQoL and/or patient satisfaction after ERAS and conventional surgery (CS). Jadad score was used to evaluate the studies. Results were divided into immediate (first week), early (second to third week) and late (more than 30 days after surgery) post-operative phases. A meta-analysis was not possible due to the heterogeneity of the studies.

Results: Ten publications were included in the final analysis. In the first week after surgery, two non-randomised trials found reduced fatigue and another 2 non-randomised studies found reduced pain with ERAS. One randomised study found increased emotional distress on SF36 in ERAS patients. At two to three weeks after surgery, none of the multidimensional HQoL measures showed any differences. Increased fatigue was reported with CS in 2 studies. Limitations in activities of daily living were more marked after CS in one study. Beyond 30 days after surgery, none of the HQoL measures showed any differences. Only one non-randomised study compared patient satisfaction after ERAS and CS and no difference was found.

Conclusion: There is no evidence that ERAS adversely affect HQoL or patient satisfaction. Certain aspects of HQoL such as pain and fatigue may improve with ERAS. Further research is required, especially in the early post-operative period.