ENHANCED RECOVERY AFTER SURGERY PROTOCOLS VERSUS CONVENTIONAL POSTOPERATIVE CARE IN ELECTIVE COLORECTAL SURGERY: A RETROSPECTIVE COHORT STUDY

Abstract

Colorectal surgery is traditionally associated with significant postoperative stress, prolonged hospital stay, and notable complications. The enhanced recovery after surgery approach integrates multimodal evidence-based perioperative care to minimize the surgical stress response and accelerate recovery [1, 4]. This retrospective observational cohort study compared enhanced recovery after surgery protocols with conventional postoperative care in patients undergoing elective colorectal surgery in a South Indian tertiary care setting. A total of 80 patients who underwent elective colorectal surgery between October 2024 and April 2026 were evaluated, with 40 managed under the enhanced recovery pathway and 40 receiving conventional perioperative care. Baseline demographics, surgical indications, and procedural types were comparable between the groups. The mean postoperative length of hospital stay was significantly shorter in the enhanced recovery group than in the conventional care group (5.3 ± 1.6 days versus 8.1 ± 2.7 days, p < 0.001) [9, 14]. Patients in the enhanced recovery pathway achieved significantly earlier times to first oral intake (1.2 ± 0.5 days versus 3.1 ± 0.9 days, p < 0.001) [8], early mobilization (1.1 ± 0.4 days versus 2.4 ± 0.8 days, p < 0.001), and passage of first flatus (1.9 ± 0.6 days versus 3.4 ± 1.1 days, p < 0.001). Mean visual analogue scale pain scores on postoperative day 1 were lower in the enhanced recovery cohort (3.1 ± 0.8 versus 4.6 ± 1.0, p < 0.001), resulting in a significantly lower requirement for postoperative opioid analgesics (40.0% versus 75.0%, p = 0.002) [4, 10]. Furthermore, the enhanced recovery group demonstrated a significantly lower overall complication rate (p = 0.04) [11, 13] and reduced severity of complications graded by the Clavien-Dindo classification (p = 0.03). The 30-day readmission rate was also significantly lower in the enhanced recovery cohort (7.5% versus 20.0%, p = 0.04) [12], while mortality did not differ significantly between the groups. In conclusion, the implementation of enhanced recovery after surgery protocols in elective colorectal procedures significantly shortens hospital stay, reduces pain and opioid dependency, accelerates functional recovery, and minimizes postoperative complications without compromising patient safety.