An overview on effectiveness of interventions delivered within inpatient perioperative care in adults undergoing surgery:A scoping review of systematic reviews

<b>Background</b>: <br/>Many perioperative interventions have been developed to improve care and health outcomes for patients. Interventions that are effective, reduce adverse events and improve patient recovery are hugely important to patients and the NHS. This study provides a contemporary overview on the effectiveness of interventions delivered within inpatient perioperative care in adults undergoing surgery. <br/><br/><b>Methods</b>: <br/>A scoping review of systematic reviews (SRs) was performed according to Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. The following databases were searched: Medline, Embase, Cochrane Library, CINAHL and PEDro. <br/><br/><b>Results</b>: <br/>190 SRs were included in the review incorporating 10 themes; Enhanced recovery after surgery (ERAS) (77/190(39%), diet/nutritional (31/190(16%), pharmaceutical (20/190 (10.8%), respiratory (15/190(8.5%), ‘other’ (13/190(7.4%), exercise/physical activity (12/190(6.5%), Comprehensive geriatric assessment (CGA) (9/190(4.5%), care-bundles 5/190(2.8%), multimodal (5/190(2.8%) and physiotherapy (3/190(1.7%). <br/><br/>Key intervention themes showed consistent benefit across a range of surgical specialties. These consisted of respiratory/aerobic strategies on length of stay (LoS), postoperative complications and 6 min walk test with little evidence for effect on mortality. Diet/nutritional; showed significant benefit on LoS, postoperative complications and surgical site infections with little or no difference observed on mortality. CGA showed beneficial effect on mortality, LoS and activities of daily living, with little evidence of effect on readmission. ERAS showed improvement on LoS, postoperative complications and morbidity, with less evidence of effect on mortality and readmission across specialties. <br/><br/><b>Conclusions</b>: <br/>Key interventions showed consistent patterns of improvement. Before improving or designing new perioperative interventions, it is important to consider and deliver strategies that have already been evaluated and are effective.