EP1024 - Impact of Enhanced Recovery After Surgery (ERAS) on Clinical Outcomes in Emergency Colorectal Surgery: A Retrospective Cohort Study

Purpose/Background: Background Enhanced Recovery After Surgery (ERAS) has improved outcomes in elective colorectal surgery, but its application in the emergency setting remains limited. This study evaluates the feasibility and effectiveness of an ERAS checklist for adult patients undergoing emergency colorectal surgery at the Philippine General Hospital (PGH).

Methods/Interventions: Methods We conducted a retrospective cohort study that included 124 adult patients who underwent emergency colorectal surgery, and compared outcomes before (pre-ERAS, n=63) and after (post-ERAS, n=61) the implementation of an enhanced recovery protocol. Key outcomes included time to return of bowel function, postoperative length of stay (LOS), 30-day morbidity rate (i.e., surgical site infection [SSI], hospital-acquired pneumonia [HAP], prolonged postoperative ileus), and 30-day mortality rate. Compliance to ERAS components across preoperative, intraoperative, and postoperative phases was assessed. Multivariable regression analyses were performed adjusting for age, ECOG score, and comorbidities.

Results/Outcomes: Results Compliance with ERAS components in this cohort ranged from low to high depending on the measure, with average compliance of 70%, 84%, and 76.6% for preoperative, intraoperative, and postoperative phases, respectively. Implementation of the ERAS protocol significantly reduced time to return of bowel function (mean 2.52 ± 1.06 vs. 3.16 ± 2.44 days; p = 0.003) and postoperative hospital LOS after adjustment for covariates (β = −0.085; 95% CI: −1.60 to −0.10; p =0.027). Rates of SSI, HAP, prolonged postoperative ileus, and 30-day mortality were comparable between groups.

Conclusion/Discussion:

Conclusions: ERAS protocols are feasible and effective in emergency colorectal surgery in our setting. Implementation was associated with improved gastrointestinal recovery and a modest reduction in length of hospital stay without increasing postoperative complications. Moderate to high adherence across preoperative, intraoperative, and postoperative components demonstrates the practicality of structured perioperative pathways, even in resource-limited environments. These findings support the continued use of evidence-based ERAS protocols and highlight the need for larger, multicenter studies to further validate their application in emergency surgical practice.

Table 1. Summary of ERAS protocol compliance across preoperative, intraoperative, and postoperative phases in emergency colorectal surgery (Post-ERAS cohort, n=61) at the Philippine General Hospital.
Table 1. Summary of ERAS protocol compliance across preoperative, intraoperative, and postoperative phases in emergency colorectal surgery (Post-ERAS cohort, n=61) at the Philippine General Hospital.
Table 2. Clinical Outcomes Before and After ERAS Implementation with Unadjusted and Multivariable-Adjusted Analyses (n=124) at the Philippine General Hospital.
Table 2. Clinical Outcomes Before and After ERAS Implementation with Unadjusted and Multivariable-Adjusted Analyses (n=124) at the Philippine General Hospital.