European Journal of Cardiovascular Medicine

Colorectal surgery is commonly associated with significant postoperative complications, prolonged hospital stays, and delayed recovery, contributing to increased healthcare costs and patient morbidity (1). Enhanced Recovery After Surgery (ERAS) protocols have emerged as an evidence-based approach designed to optimize perioperative care through a multidisciplinary framework that encompasses preoperative, intraoperative, and postoperative strategies aimed at minimizing physiological stress and accelerating recovery (2,3). Initially introduced in the late 1990s for colorectal surgery, ERAS protocols have been widely adopted across various surgical specialties due to their proven efficacy in enhancing clinical outcomes (4).

The key principles of ERAS include patient education, reduced fasting periods, carbohydrate loading, multimodal analgesia, early postoperative mobilization, and prompt resumption of oral intake (5). These strategies are tailored to decrease surgical stress, maintain normal physiological function, and promote early discharge from the hospital (6). Compared to traditional perioperative care, ERAS protocols have demonstrated significant reductions in postoperative complications, length of hospital stay, and overall healthcare costs in various studies (7-9).

Furthermore, the application of ERAS principles has been associated with enhanced postoperative recovery, improved patient satisfaction, and reduced opioid consumption (10,11). However, despite the well-documented benefits, the implementation of ERAS protocols remains inconsistent across healthcare institutions, particularly in low-resource settings (12).

This study aims to evaluate the effectiveness of ERAS protocols in reducing postoperative complications among patients undergoing colorectal surgery and to compare the outcomes with conventional perioperative care.

Study Design and Setting:

This was a prospective, randomized controlled trial conducted at a tertiary care hospital over a period of 12 months. The study aimed to evaluate the effectiveness of Enhanced Recovery After Surgery (ERAS) protocols in reducing postoperative complications in patients undergoing elective colorectal surgery.

Study Population:

A total of 200 adult patients (aged 18–75 years) scheduled for elective colorectal surgery were enrolled in the study. Patients were randomly assigned into two groups:

• ERAS Group (n = 100): Received perioperative care based on standardized ERAS protocols.
• Conventional Care Group (n = 100): Received standard perioperative care based on traditional protocols.

Inclusion criteria included patients undergoing elective colorectal surgery with American Society of Anesthesiologists (ASA) grades I to III. Exclusion criteria included emergency surgeries, patients with ASA grade IV or higher, pre-existing severe organ dysfunction, or inability to comply with follow-up procedures.

Intervention (ERAS Protocol):

The ERAS group was managed according to established ERAS guidelines which included:

• Preoperative Care: Patient education, carbohydrate loading, and avoidance of prolonged fasting.
• Intraoperative Care: Multimodal analgesia, minimally invasive surgical techniques where applicable, and optimized fluid management.
• Postoperative Care: Early mobilization, early oral intake, and pain management with minimal opioid use.

The conventional care group received routine perioperative management, which involved overnight fasting, routine intravenous analgesia, and delayed oral intake until bowel function was confirmed.

Data Collection:

Data were collected on demographic characteristics, surgical details, postoperative complications, length of hospital stay, readmission rates, and patient satisfaction. Postoperative complications were monitored and documented for up to 30 days post-surgery.

Outcome Measures:

The primary outcome was the incidence of postoperative complications within 30 days of surgery. Secondary outcomes included the length of hospital stay, readmission rates, and patient satisfaction scores.

Statistical Analysis:

Data were analyzed using Statistical Package for the Social Sciences (SPSS) software version 27. Continuous variables were expressed as mean ± standard deviation (SD) and compared using the independent t-test. Categorical variables were expressed as frequencies and percentages, and comparisons were made using the Chi-square test or Fisher’s exact test where appropriate. A p-value of <0.05 was considered statistically significant.

The study included a total of 200 patients undergoing elective colorectal surgery, with 100 patients in the ERAS group and 100 patients in the conventional care group. The demographic characteristics of the study population were comparable between the two groups, as shown in Table 1.

Patient Demographics

The mean age of patients in the ERAS group was 52.4 ± 12.3 years, while that in the conventional care group was 53.1 ± 11.8 years. The distribution of males and females was similar between the groups, with a male-to-female ratio of 1.3:1 in the ERAS group and 1.4:1 in the conventional care group (Table 1).

Table 1: Demographic Characteristics of Study Participants

Postoperative Complications

The incidence of postoperative complications was significantly lower in the ERAS group (20%) compared to the conventional care group (40%) (p = 0.002). The most common complications observed were wound infection, anastomotic leakage, and pneumonia (Table 2).

Table 2: Postoperative Complications

Length of Hospital Stay and Readmission Rates

The mean length of hospital stay was significantly reduced in the ERAS group (5.2 ± 1.4 days) compared to the conventional care group (7.8 ± 2.1 days) (p < 0.001) (Table 3). The readmission rates within 30 days were similar between the groups, with 5% in the ERAS group and 6% in the conventional care group (p = 0.78).

Table 3: Length of Hospital Stay and Readmission Rates

Patient Satisfaction

Patient satisfaction scores were significantly higher in the ERAS group (8.7 ± 1.1) compared to the conventional care group (6.3 ± 1.5) (p < 0.001) (Table 4).

Table 4: Patient Satisfaction Scores

The findings of this study demonstrate that the implementation of Enhanced Recovery After Surgery (ERAS) protocols significantly reduces postoperative complications and hospital stay among patients undergoing elective colorectal surgery compared to conventional perioperative care. These results are consistent with previous studies that have reported the efficacy of ERAS protocols in enhancing postoperative outcomes (1,2).

A key outcome of this study was the significant reduction in postoperative complications in the ERAS group (20%) compared to the conventional care group (40%). This finding aligns with the results of several meta-analyses and systematic reviews, which have consistently shown that ERAS protocols reduce overall morbidity and postoperative complications in colorectal surgery (3–5). A recent meta-analysis by Zhuang et al. (2013) reported a similar reduction in complications, emphasizing the importance of implementing ERAS guidelines to optimize surgical outcomes (6).

The reduced incidence of wound infection, anastomotic leakage, and pneumonia observed in the ERAS group can be attributed to improved perioperative practices, including optimized fluid management, early mobilization, and the use of multimodal analgesia, all of which reduce the physiological stress response to surgery (7,8). Furthermore, the avoidance of prolonged fasting and early resumption of oral intake have been shown to enhance gastrointestinal recovery, thereby decreasing the risk of complications such as anastomotic leakage (9).

The shorter length of hospital stay observed in the ERAS group (5.2 ± 1.4 days) compared to the conventional care group (7.8 ± 2.1 days) is consistent with previous reports demonstrating reduced hospitalization duration following the application of ERAS protocols (10–12). Early mobilization and the use of opioid-sparing analgesia contribute to enhanced recovery, allowing patients to be safely discharged sooner than those receiving traditional care (13,14).

Patient satisfaction was also significantly higher in the ERAS group, likely due to a more efficient recovery process with fewer complications and reduced discomfort. A study by Hughes et al. (2018) highlighted that patient education and involvement in perioperative care, as emphasized in ERAS protocols, contribute to higher satisfaction scores (15). This finding underscores the importance of patient engagement and education as integral components of the ERAS approach.

The present study has some limitations that should be acknowledged. First, the study was conducted at a single tertiary care hospital, which may limit the generalizability of the findings. Second, the sample size was relatively small, and a larger multicentre trial may be necessary to further validate the results. Third, although patients were followed up for 30 days postoperatively, long-term outcomes such as quality of life and functional recovery were not assessed. Future research should focus on the implementation of ERAS protocols in resource-limited settings and assessing their cost-effectiveness. Additionally, further studies evaluating the long-term impact of ERAS protocols on patient recovery and quality of life are warranted.

Overall, this study supports the adoption of ERAS protocols in colorectal surgery as a safe and effective approach for reducing postoperative complications, shortening hospital stays, and improving patient satisfaction.

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