EFFECT OF AN ERAS (ENHANCED RECOVERY AFTER SURGERY) BUNDLE ON 30-DAY POSTOPERATIVE COMPLICATIONS AND LENGTH OF HOSPITAL STAY AFTER ELECTIVE COLORECTAL RESECTION: A PROSPECTIVE COMPARATIVE STUDY

Abstract

Objective: To compare the frequency of 30-day postoperative complications and postoperative length of hospital stay between patients managed with a standardized Enhanced Recovery After Surgery (ERAS) bundle and those receiving conventional perioperative care after elective colorectal resection. Study Design: Prospective, quasi-experimental, non-randomized before-and-after comparative study. Setting: Department of Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Period: Five months from 5 December 2025 to 18 April 2026, following approval from Institutional Review Board clearance. Material & Methods: Ninety-six adults undergoing elective open or laparoscopic colorectal resection were enrolled by non probability purposive sampling. The first 48 consecutive patients (Group A) received the department's existing conventional perioperative care; the next 48 (Group B) received an eight-element ERAS bundle covering counselling, avoidance of prolonged fasting, opioid-sparing analgesia, restrictive fluid therapy, normothermia, selective nasogastric use, early oral feeding and early mobilization. The primary outcomes were any 30-day postoperative complication (Clavien-Dindo grade I V) and postoperative length of stay. Groups were compared using the chi-square test, independent-samples t-test and Mann Whitney U test, with multivariable logistic and linear regression to adjust for age, ASA grade, operative approach, site, diagnosis and diabetes; p≤0.05 was significant. Results: Groups were comparable for age, sex, ASA grade, operative approach, site and diagnosis. Mean ERAS compliance was 7.1±1.0 of 8 elements (89%), with 44/48 (91.7%) achieving ≥6/8. Thirty-day complications occurred in 27/48 (56.3%) conventional-care patients versus 16/48 (33.3%) ERAS patients (relative risk 0.59, 95% CI 0.37-0.95; p=0.040). Major complications (Clavien-Dindo ≥IIIa) were similar (12.5% versus 12.5%; p=1.000). Mean postoperative stay fell from 7.25±1.68 days to 4.19±1.48 days with the ERAS bundle (mean difference 3.06 days, 95% CI 2.45-3.66; p<0.001). On adjusted analysis, ERAS remained independently associated with lower complication odds (adjusted odds ratio 0.27, 95% CI 0.09-0.78; p=0.016) and shorter stay (adjusted difference −3.05 days; p<0.001). Conclusion: A pragmatic, locally deliverable ERAS bundle significantly reduced 30-day postoperative complications and postoperative length of stay after elective colorectal resection at a high-volume public-sector centre, supporting its adoption as standard perioperative practice.