# Time to Start a New Enhanced Recovery After Surgery (ERAS): A Retrospective Cohort Study

## TL;DR

This study assesses the implementation of ERAS protocols in a colorectal surgery center and finds gaps in preoperative optimization and postoperative care.

## Contribution

The study provides a diagnostic assessment of ERAS® adherence in a local surgical center, highlighting areas for improvement.

## Key findings

- Deficient preoperative optimization was observed, particularly in nutritional counseling and anemia treatment.
- Postoperative delays in removing invasive devices and starting oral intake contributed to longer hospital stays and complications.
- The study suggests that implementing ERAS® protocols could improve recovery outcomes at the hospital.

## Abstract

Background: The enhanced recovery after surgery (ERAS®) is a multimodal perioperative care pathway designed to reduce surgical stress and ultimately improve patient recovery and outcome. It can require significant resources but with proven benefits. The main goal of this study was to perform a diagnostic assessment of perioperative practice in a local colorectal surgical center.

Methods: 93 patients who underwent elective colorectal surgery from January to December 2022 were analyzed. Preadmission, preoperative, and postoperative data of all patients were collected in a database developed by the researchers, according to ERAS® guidelines. Descriptive statistics were employed to summarize demographic and clinical characteristics. Chi-square and T-test were performed to identify possible associations between categorical variables and postoperative complications.

Results: Overall analysis showed deficient preoperative patient optimization, especially regarding nutritional counseling and supplementation, smoking and alcohol cessation, anemia treatment (9%), and pre-anesthetic medication (42%). Removal of invasive devices was significantly delayed (removal of urinary catheter average on the fourthday and surgical drain average on the fifth day) in the postoperatively period and oral intake (average onset on the sixth day). Both contribute to hospital length of stay (mean of 13 days) and a significant number of complications.

Conclusion: The results lead us to an individual and multidisciplinary reflection on current practices and outcomes. ERAS® program, already adopted by many centers, could have a positive impact on the immediate postoperative recovery of colorectal patients in Funchal Central Hospital and implementation seems necessary.