Enhanced recovery after surgery in diverticular disease: A multicenter comparison with colorectal cancer

ERAS protocols are widely used in colorectal surgery, yet their impact on outcomes in diverticular disease (DD) is unclear. The primary aim of this study was to compare postoperative complication rates after left-sided colon resections for either DD or left-sided colonic cancer within an ERAS pathway, the secondary aim was to assess ERAS protocol compliance.

This retrospective multicenter cohort study used data from the Swedish ERAS® Interactive Audit System (EIAS) from 2010 to 2020. All participating centers consecutively register elective colorectal procedures in patients aged ⩾ 18 years. We included all adult patients undergoing elective left-sided colonic or sigmoid resection at participating centers, where all procedures are mandatorily registered within a standardized ERAS pathway, with no additional exclusions. ERAS protocol compliance (pre- and intraoperative items), postoperative symptoms, and postoperative complications were assessed according to ERAS® guidelines and compared between diagnostic groups. Associations between variables and outcomes were evaluated using logistic regression.

A total of 3774 patients were included (879 with DD and 2895 with cancer). Patients in the DD group were younger and had fewer comorbidities. ERAS compliance was similar between groups (86.3% for DD vs 86.7% for cancer). In multivariable analysis, there was no statistically significant difference in severe complications (Clavien-Dindo grade III-IV) between the DD and cancer groups (11.8% vs 13.1%; OR = 0.97, 95% CI = 0.87-1.09). However, DD was associated with a higher rate of overall complications (39.2% vs 36.5%; OR = 1.27, 95% CI = 1.07-1.52), particularly infectious complications (17.0% vs 12.1%; OR = 1.55, 95% CI = 1.23-1.97), including intra-abdominal abscesses (3.5% vs 2.3%; OR = 1.62, 95% CI = 1.01-2.60). In addition, DD patients were more likely to experience postoperative pain that delayed hospital discharge (5.2% vs 2.4%, OR = 1.78, 95% CI = 1.17-2.70).

Despite similar adherence to the ERAS protocol, surgery for DD was associated with a higher overall rate of postoperative complications and similar rates of severe complications as surgery for colonic cancer. The considerable risk of complications should be carefully considered when counseling patients with DD for elective surgery.