Implementation of an Enhanced Recovery After Surgery (ERAS) Program in Colorectal Surgery: The Benefits of Late Adoption

Abstract Background Enhanced recovery after surgery (ERAS) protocols have shown beneficial outcomes in various surgical fields in the last 20 years. Nevertheless, some benefits such as lower complication rates, shorter length of stay and cost reduction might be related to other, simultaneously implemented technical improvements such as a minimally-invasive access or modified anesthesiology care. Aims To analyze the effects after the implementation of an ERAS protocol in 2021 in a high-volume colorectal center. Methods This is a propensity score matched single-center study comparing the short-term outcomes and cost analysis of patients undergoing elective colorectal surgery in an ERAS program from 2021 to August 2022 compared to regular perioperative care from 2019 to 2020. Results A total of 738 patients underwent elective colorectal surgery between 2019 and August 2022. 456 patients were included in the propensity score matched analysis with 228 patients per group (ERAS vs. non-ERAS). The predominant access in both groups was minimally-invasive with 78%; 17% were rectal procedures. There was no significant difference in age, sex, insurance status, body mass index, Charlson's Comorbidity Index, tumor entity and type of surgery between groups. Major complications (grade 3a or higher according to Clavien-Dindo) occurred in 6.6% vs. 7% (p=0.85) and anastomotic leakage demanding operative revision in 2.2% vs. 2.6% (p=0.68) in the ERAS and non-ERAS group, respectively. Mean length of stay (LOS) and mean costs per case were significantly lower in the ERAS group compared to the non-ERAS group (LOS 9.2 days vs. 12.7 days, p=0.001; costs 30’114 francs vs. 35’991 francs, p=0.004). At 30-day telephone follow-up, 97% of patients in the ERAS group were in a good general state and mean overall satisfaction level was at 9.2/10. Conclusions Late adoption to an ERAS protocol leads to a significant reduction of LOS and costs without increasing perioperative morbidity.