Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol in a General Surgical Unit: A Prospective Cohort Study on Outcomes in Colorectal Surgery

Abstract

Background: Enhanced Recovery After Surgery (ERAS) protocols improve outcomes in elective colorectal surgery, but their efficacy in general surgical units, as opposed to specialized high-volume centres, is less established. This study evaluated the impact of a standardized ERAS protocol in a general surgical unit in Malaysia. Methods: A prospective observational study was conducted comparing 60 patients managed under a 24-element ERAS protocol to a historical cohort of 56 patients managed with traditional care. All patients underwent elective colorectal resection for malignancy. The primary outcomes were length of hospital stay (LOS), postoperative complication rates (Clavien-Dindo classification), 30-day readmission, and 30-day mortality. Adherence rate to the ERAS protocol was evaluated as the secondary outcome. Results: Baseline demographics were comparable between groups. The ERAS group demonstrated a significant reduction in median LOS (5 days [IQR: 2] vs. 8 days [IQR: 5], p<0.001) and a significantly higher rate of patients with no postoperative complications (58.3% vs. 44.6%, p=0.006). The rate of major complications (Clavien-Dindo ≥III) was nearly halved (10.0% vs. 17.9%). There were non-significant trends toward reduction in 30-day readmission (11.7% vs. 17.9%) and mortality (1.7% vs. 7.1%). Overall, ERAS protocol compliance was high (>70% for most elements). Conclusion: The implementation of a multidisciplinary ERAS protocol in a general surgical unit is feasible and effective. It significantly reduces length of stay and postoperative morbidity for patients undergoing elective colorectal surgery, demonstrating that the benefits of ERAS can be successfully translated beyond specialized centres into a broader surgical setting.