Impact of Charlson Comorbidity Index (CCI) on Enhanced Recovery after Surgery (ERAS) in colorectal surgery...

Enhanced recovery after surgery (ERAS) is a widely accepted program aimed at improving short-term outcomes in patients undergoing colorectal surgery. To achieve good postoperative outcomes, adherence of at least 75% to ERAS principles is required, which is particularly challenging during the postoperative period.

Patients undergoing colorectal resection between May 2016 and October 2022 were prospectively enrolled in the ERAS protocol and stratified according to the retrospectively assessed CCI. Patients with ≥ 5% missing data were excluded. The primary outcome was to evaluate the predictive value of the Charlson Comorbidity Index (CCI) for achieving adequate postoperative ERAS adherence (≥ 75%).

A total of 572 patients were included (CCI 0: 223 [39.0%], CCI 1: 41 [7.2%], CCI 2: 150 [26.2%], CCI 3: 71 [12.4%], CCI ≥ 4: 87 [15.2%]). Patients with a CCI score of 0 had a median postoperative ERAS adherence of 84.6% (range: 15.4-100) compared with 69.2% (range: 16.7-100) in patients with a CCI score of ≥ 4 (p < 0.001). Increasing CCI was significantly associated with a higher complication index (p < 0.001) and a longer length of hospitalization stay (p < 0.001). In the multivariate analysis, CCI ≥ 2 was an independent predictor of failure to achieve adequate postoperative ERAS adherence (≥ 75%).

Higher CCI was associated with lower postoperative ERAS adherence. Based on these findings, an exploratory risk-stratification algorithm is proposed to facilitate the preoperative identification of patients at increased risk for inadequate postoperative ERAS adherence.