Predicting Postoperative Complications in Patients Undergoing Colorectal Surgery with an Enhanced Recovery Pathway

Reducing postoperative complications is the essential requirement of the enhanced recovery after surgery (ERAS) program. This study aimed to identify the key perioperative components affecting postoperative complications in patients undergoing colorectal surgery with ERAS.

This retrospective cohort study included all patients who underwent major colorectal surgery with ERAS program between February 2019 and June 2020, all perioperative information was retrieved from a database. Univariate and multivariate logistic regression analyses were used to identify predictors for complications within 30 days postoperatively, and a nomogram model was drawn to visualize the model. Receiver operating characteristic curve (ROC) and calibration curve were used to evaluate the model performance.

We enrolled 649 patients and 72 patients (11.1%) had at least 1 complication within 30 days postoperatively. Multivariate analyses showed that minimally invasive surgery [odds ratio (OR) 0.323; 95% confidence interval (CI) 0.168-0.620] was associated with a decreased of the complications. However, preoperative anemia (OR 2.052; 95%CI 1.073-3.928) and old age (OR 1.927; 95%CI 1.022-3.632) were independent risk factors for complications within 30 days postoperatively. The C-index of the nomogram was 0.735 (95%CI 0.694-0.776). Calibration curve showed a relatively good agreement between predicted value and observed outcome. In the validation set, the nomogram showed an area under the ROC curve of 0.729 (95%CI 0.680-0.778).

This study suggests that preoperative anemia, old age and minimally invasive surgery may individually influence the prognosis of patients undergoing major colorectal surgery with an enhanced recovery pathway. Trial registration Clinical Trial Registry (number: ChiCTR2000037513).