The impact of variations in care and complications within a colorectal enhanced recovery after surgery (ERAS) program on length of stay.

Purpose Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay. Methods This study was a single-centre review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on length of stay (LOS). The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, surgical site infections) on LOS. ERAS interventions, rate of adherence, length of stay, readmissions, morbidity and mortality was recorded and analysis was performed on SPSS. Results While there was a high agreement rate for pre-operative ERAS strategies, there was a lower agreement rate for post-operative ERAS interventions. ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. Conclusion Seven ERAS interventions were identified as the most important strategies in reducing LOS. These include laparoscopic surgery, mobilisation twice daily post-operative day (POD) 0-1, discontinuation of intravenous fluids on POD 0-1, upgrading to solid diet by POD 0-2, removal of indwelling catheter by POD 0-2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS.