ERAS Implementation Fidelity, Care Complexity, and Postoperative Outcomes in Oncological Colorectal Surgery: A...

Area of Science:

• Surgical Oncology
• Perioperative Medicine
• Healthcare Management

Background:

• Enhanced Recovery After Surgery (ERAS) programs are evidence-based perioperative pathways.
• Implementation fidelity is crucial for ERAS program success, but its impact on outcomes alongside care complexity is understudied.
• Real-world data on ERAS adherence and its correlation with patient outcomes are limited.

Purpose of the Study:

• To assess the association between ERAS adherence and postoperative length of stay in oncological colorectal surgery.
• To investigate the potential influence of Care Complexity Individual Factors (CCIFs) on the ERAS adherence-outcome relationship.
• To evaluate ERAS adherence across different perioperative phases.

Main Methods:

• Retrospective observational cohort study of 90 adult patients undergoing elective colorectal cancer surgery.
• Assessment of ERAS adherence globally and by perioperative phase (pre-, intra-, postoperative) using structured indicators.
• Classification of Care Complexity Individual Factors (CCIFs) into five domains and bivariate analysis of associations.

Main Results:

• Overall ERAS adherence was 64%, with higher adherence linked to significantly shorter hospital stays (median 4 vs. 5 days) and better compliance with expected length of stay.
• ERAS adherence varied by phase, being highest preoperatively and lowest postoperatively.
• High care complexity (mean CCIF 2.62) did not significantly impact ERAS adherence or length of stay compliance.

Conclusions:

• Higher ERAS adherence is associated with reduced hospital length of stay in oncological colorectal surgery in a real-world setting.
• Implementation fidelity across the entire perioperative pathway is critical for achieving optimal patient recovery.
• Further research with multivariable analyses and patient-centered outcomes is needed to explore care complexity interactions.