Enhanced Recovery After Surgery (ERAS®) Protocol in Colorectal Resections: A Prospective Observational Study of Implementation and Outcomes at a Tertiary Referral Center.

Aim: This study aimed to evaluate the implementation of the Enhanced Recovery After Surgery (ERAS®) protocol in patients undergoing colorectal cancer resections at a tertiary care center in India, and to assess whether protocol compliance influences the length of hospital stay and postoperative complications.

Materials And Methods: We conducted a prospective observational study of 50 consecutive patients undergoing colorectal cancer resection surgery at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, between May 2024 and April 2025. A 16-item ERAS® protocol was implemented, and compliance was measured. Primary outcomes included the length of hospital stay, postoperative complications (classified according to the Clavien-Dindo classification), and 30-day readmission rates.

Results: Overall compliance with the ERAS® protocol was 78.6% across all 50 patients. Mean length of stay was 6.3 ± 2.7 days, with significantly shorter stays in patients who achieved >80% compliance (24/50 patients, 5.2 ± 1.8 days) compared with those below this threshold (26/50, 7.6 ± 3.0 days; p=0.003). The overall complication rate was 24% (12/50), while major complications (Clavien-Dindo grade ≥ III) occurred in 8% (4/50). The 30-day readmission rate was 4% (2/50). Greater compliance was associated with fewer overall complications (4/24 (16.7%) vs. 11/26 (42.3%); p=0.038), although it did not significantly influence major complications or readmissions.

Conclusions: The implementation of the ERAS® protocol in colorectal cancer surgery is feasible in a resource-constrained setting, with acceptable compliance rates. Higher compliance was associated with shorter hospital stay and reduced overall complication rates. The protocol can be safely applied to patients undergoing colorectal cancer surgeries, potentially improving outcomes and resource utilization.