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Review
. 2024 Feb 29:70:102510.
doi: 10.1016/j.eclinm.2024.102510. eCollection 2024 Apr.

Exploring the need for reconsideration of trial design in perioperative outcomes research: a narrative review

Henrik Kehlet  1 , Dileep N Lobo  2   3   4   5
Affiliations
Review

Exploring the need for reconsideration of trial design in perioperative outcomes research: a narrative review

Henrik Kehlet et al. EClinicalMedicine. .

Abstract

"Enhanced recovery after surgery" is a multimodal effort to control perioperative pathophysiology and improve outcome. However, despite advances in perioperative care, postoperative complications and the need for hospitalisation and prolonged recovery continue to be challenging. This is further complicated by procedure-specific and patient-associated risk factors, given the increase in the number of elderly and frail patients with multiple comorbidities undergoing surgery. This paper is a critical assessment of current methodology for trials in perioperative medicine. We make a plea to reconsider the design of future interventional trials to improve surgical outcome, based upon studies of potentially effective interventions, but often without improvements in recovery. The complexity of perioperative pathophysiology necessitates a procedure- and patient-specific approach whenever outcome is assessed or interventions are planned. With improved understanding of perioperative pathophysiology, the way to improve outcomes looks promising, provided that knowledge and established enhanced recovery programmes are integrated in trial design.

Funding: None.

Keywords: Enhanced recovery after surgery; Interventions; Outcomes; Perioperative medicine; Trial design.

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Conflict of interest statement

HK has no conflicts of interest to declare. DNL has received an unrestricted educational grant from B Braun and speaker's honoraria from Nestlé, Abbott and Corza for unrelated work. DNL is also the Scientific Chair of the ERAS® Society.

Figures

Fig. 1
Fig. 1
Elements of Enhanced Recovery After Surgery (ERAS) programme.
See this image and copyright information in PMC

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