Patient Experiences of Nutrition in Enhanced Recovery After Colorectal Surgery: A Systematic Review

Background and Objectives: Perioperative nutrition is a core component of Enhanced Recovery After Surgery (ERAS) pathways. Understanding the patient experience of nutrition recommendations provides insight into the acceptability of perioperative nutrition care and facilitates the achievement of ERAS targets. This systematic review aimed to synthesise patients' experiences of nutrition within ERAS pathways for colorectal surgery. Methods: A systematic search of Ovid MEDLINE, Embase, Emcare, and CINAHL was conducted to identify studies published up until July 2025. Eligible studies included qualitative, mixed-methods, or descriptive survey designs. Data were extracted and synthesised using an inductive thematic analysis. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Results: Fifteen studies were included (40% qualitative, 33% quantitative, 27% mixed-methods), representing data from 1431 patients. Eleven studies met all quality criteria. Five themes were identified. Information gaps and misconceptions about nutrition (Theme 1) resulted from unclear advice across care settings. Oral intake post-surgery (Theme 2) was limited by nausea, reduced appetite, early satiety, and dissatisfaction with hospital food. Experiences with oral nutritional supplements (Theme 3) were variable, with palatability affecting acceptability. Healthcare professionals (Theme 4) were central in shaping patient confidence in nutrition care. The transition to home (Theme 5) was a vulnerable period where follow-up support was highly valued. Heterogeneous reporting of nutrition in ERAS contexts was a limitation. Conclusions: Patient engagement with ERAS nutrition is shaped by individual and healthcare system factors. Addressing information gaps, providing nutrition support, and integrating patient perspectives through codesigned education and research initiatives may enhance perioperative nutrition experiences and optimise recovery outcomes.