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ENHANCED RECOVERY: FROM PRINCIPLES TO PRACTICE IN UROLOGY

Publication of the 1995 Calman-Hine report [1] and, more latterly, Improving Outcomes Guidance [2] should ensure that postoperative surgical outcomes will be subject to increasing scrutiny. In the UK, recent initiatives to improve surgical performance within urology have focused primarily on ensuring that complex procedures are performed in highvolume centres, with regular robust audit of institutional outcomes. Although progress has been made, a significant proportion of patients undergoing major urological surgery still have morbidity, mortality and prolonged length of stay, with clear variation among institutions. Studies of institutions delivering ‘best practice’ have shown that this is usually a ‘centre effect’ rather than a ‘surgeon effect’, although for prostate cancer there is strong evidence that the surgeon is critically important.