What is the role of post-operative physiotherapy in general surgical Enhanced Recovery after Surgery pathways?

Purpose: Enhanced Recovery after Surgery (ERAS®) has improved outcomes following elective surgery. This narrative review aimed to assess current evidence for post-operative physiotherapy interventions in general surgical procedures which adopt ERAS® principles.Materials and methods: A systematic review of the literature between 2000 and 2017 was conducted. Randomised controlled trials (RCTs) that compared physiotherapy interventions for patients after the following elective ERAS® procedures were included: gynaecologic, gastrectomy, gastrointestinal, pancreatic, bariatric, head and neck, breast, cystectomy, colorectal, colonic and liver.Results: One study (two publications) was found to compare post-operative physiotherapy interventions in radical cystectomy patients on an ERAS® pathway. The addition of a progressive exercise-based intervention improved aspects of health-related quality of life (dyspnoea (p <.05), constipation (p <.02) and abdominal flatulence (p ≤ .05)). Enhanced mobilisation was achieved, but no differences were observed in length of stay or severity of complications.Conclusions: It is essential that the paucity of research to assess post-operative physiotherapy interventions within ERAS® cohorts is highlighted. The results of our literature search highlight that there is a role for post-operative physiotherapy in ERAS® pathways. However, without well-conducted RCTs to evaluate procedure-specific interventions, the optimal type, timing, and dose will not be found and the potential for improving patient functional recovery will be limited.