Evaluation of Enhanced Recovery after Surgery (ERAS) Protocol versus Conventional Perioperative Care in Elective Laparoscopic Colorectal Surgery: A Prospective Comparative Study of Length of Stay and 30-Day Morbidity

Abstract

Background: Conventional perioperative care for colorectal surgery is associated with prolonged hospitalisation, delayed return of bowel function and substantial postoperative morbidity. The Enhanced Recovery after Surgery (ERAS) protocol is an evidence-based, multimodal perioperative care pathway that aims to attenuate the surgical stress response and accelerate functional recovery. The present study evaluated the impact of an ERAS protocol on length of hospital stay and 30-day morbidity in patients undergoing elective laparoscopic colorectal surgery. Methods: A prospective, comparative, parallel-group study was conducted over 12 months in a tertiary care surgical unit. One hundred consecutive adults undergoing elective laparoscopic colorectal resection were sequentially allocated to receive either an ERAS protocol (n = 50) or conventional perioperative care (n = 50). The primary outcome was the postoperative length of hospital stay. Secondary outcomes included time to return of bowel function, time to tolerance of solid diet, independent mobilisation, 30-day postoperative complications stratified by the Clavien-Dindo classification, 30-day readmission rate and postoperative pain scores. Results: The two groups were comparable at baseline. The mean postoperative length of stay was significantly shorter in the ERAS group (4.6 ± 1.6 days versus 7.2 ± 2.4 days, mean difference 2.6 days; p < 0.001). Time to first flatus (1.8 ± 0.6 versus 3.1 ± 0.9 days; p < 0.001), tolerance of solid diet (1.9 ± 0.7 versus 3.5 ± 1.0 days; p < 0.001) and independent mobilisation (1.5 ± 0.5 versus 2.8 ± 0.8 days; p < 0.001) were all significantly earlier in the ERAS group. Postoperative complications occurred in 9 patients (18.0%) in the ERAS group and 18 patients (36.0%) in the conventional group (p = 0.04). Thirty-day readmission rates were comparable (8.0% versus 12.0%, p = 0.51) and there was no 30-day mortality. Conclusion: Implementation of an ERAS protocol in elective laparoscopic colorectal surgery resulted in significantly shorter hospital stay, earlier return of bowel function and a lower overall rate of 30-day postoperative complications, without an increase in readmissions. These findings support the routine adoption  of ERAS pathways as the standard of perioperative care for elective laparoscopic colorectal surgery.