ERAS and minimally invasive colorectal surgery: the archetypal non-adherent patients

To identify patient characteristics influencing adherence to active ERAS items in elective colorectal surgery.

A single-center, prospective observational real-world study. Elective colorectal surgery patients, following the ERAS protocol and using the mobile application iColon, a mobile application customized for elective colorectal surgery patients, at IRCCS Sacro Cuore Don Calabria Hospital of Negrar di Valpolicella (VR) from September 2020 to July 2023 were included. The primary outcome was to identify the characteristics of patients who were non-adherent to ERAS active items, classified into two categories (weakly non-adherent and strongly non-adherent). The secondary aim was to describe the relationship between adherence extent and postoperative outcomes.

Six hundred and fifty-six patients were included. The main characteristics associated with low adherence in the preoperative and hospitalization phases were advanced age, inflammatory bowel disease (IBD) and American Society of Anesthesiologists (ASA) status 3 and 4. In the preoperative phase, adherent and weakly non-adherent patients experienced fewer postoperative complications and had a shorter hospital stay. A positive correlation between postoperative complications and longer hospitalization was apparent among ASA status 3 and 4 patients and those aged 75 years or over. The presence of a stoma and abdominal drainage correlated with a longer hospital stay.

Elderly, IBD and ASA 3 and 4 patients were at major risk of low adherence to the ERAS protocol. Active adherence in the preoperative phase positively influenced postoperative outcomes.