Enhanced Recovery Program (ERAS) and Colorectal Surgery: A Systematic Review and Meta-analysis

Background: Enhanced Recovery after Surgery (ERAS) protocols are rapidly becoming the standard of care for patients undergoing an elective colorectal surgical operation to speed recovery and decrease the postoperative length of stay (LOS) and morbidity. Aim: This work aims to determine the efficacy and safety of the Enhanced Recovery Program (ERAS) on postoperative outcomes in colorectal surgery patients. Materials and Methods: A systematic search was performed over different medical databases to identify General Surgery studies, which studied the outcome of the ERAS group versus the Conventional group of colorectal surgery patients. Using the meta-analysis process, either with fixed or random-effects models, we conducted a meta-analysis on length of hospital stay as a primary outcome and overall complications and mortality rates as a secondary outcome. Results: Ten studies were identified involving colorectal surgery patients, 3421 patients, with 1988 patients in the ERAS group, and 1433 patients in the Conventional group. The meta-analysis process revealed a highly significant decrease in mean length of hospital stay (LOS), in the ERAS group compared to the Conventional group (p<0.001). We also found a significant decrease in complications rate in the ERAS group compared to the Conventional group (p=0.022), and a highly significant decrease in mortality rate in the ERAS group compared to the Conventional group (p=0.005). Conclusion: To conclude, ERAS program is an evidence-based multimodal perioperative protocol focused on stress reduction and the promotion of a rapid postoperative recovery. ERAS helps lowering both recovery time and postoperative complication rates while being cost-effective at the same time.