Influence of ERAS protocol on postoperative outcomes after elective colorectal resection surgery: A prospective cohort study- two years single center experience

Abstract

Background ERAS (Enhanced Recovery After Surgery) protocol is a multimodal pathway of perioperative surgical care consisting of evidence-based procedures. ERAS protocol is hardly accepted by medical staff because it often opposes well established practice. Methods We analyzed length of hospital stay, postoperative complications, time until first stool passage and introduction of normal nutrition in patients undergoing elective colorectal resection surgery in University Hospital Center Split from October 2016. to October 2018. Patients were divided into 4 groups considering operation type (open/laparoscopic) and application of ERAS protocol (good/poor). Application of 60% or more ERAS steps was considered as well performed protocol. Results Groups Laparoscopy/ERAS and Open/ERAS had shorter postoperative hospital stay (Median, IQR; days) than groups Laparoscopy/non-ERAS and Open/non-ERAS (LE 5, 4-8 , OE 6, 5-9 vs LNE 7, 5-8,5 , ONE 7, 6-12). Similar difference was shown in times until first stool passage. Patients operated laparoscopically had shorter times until normal food tolerance (Median, IQR; days): LE 3, 2-3, LNE 3, 2-4 than patients who underwent open surgery (OE 3, 3-4, ONE 4, 3-5). In addition, laparoscopically operated patients had lower overall morbidity (P<0.001). Incidence of unplanned operations and hospital readmissions did not differ significantly among groups. Conclusions Well performed ERAS protocol can improve length of hospital stay and time until first stool passage in both open and laparoscopic types of operation. Optimal combination for colorectal resection is laparoscopic surgery with ERAS protocol. If open surgery is done, it should be preferably applied with ERAS protocol as well.