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Abstract

IMPORTANCE Enhanced Recovery after Surgery (ERAS) is a program designed to minimize surgery-related stress and total length of stay at the hospital in patients undergoing major surgical intervention. It has proven to enable patients to recover quickly with lesser readmissions and risk of morbidity and mortality. This study aims to compare the outcomes of ERAS protocols with those of traditional care in colorectal surgery. 
METHODS A PRISMA-compliant literature search was performed on the PubMed and Cochrane library and 29 eligible RCTs were extracted in which ERAS protocol was compared with conventional care in colorectal surgery.
RESULTS Twenty-nine RCTs included 4349 patients; 2164 in the ERAS care group and 2185 in the traditional care group. ERAS group had reduced time to flatus resumption (Weighted mean difference (WMD): —0.78 days, 95% CI —1.05 to —0.52, p  < 0.00001), a shorter total length of stay (WMD: -3.13 days, 95% CI —4.16 to —2.10, p < 0.00001) and postoperative hospital stay (Weighted Mean Difference: —2.21 days, 95% CI —2.87 to —1.55, p < 0.00001), shorter time to mobilization (WMD: —16.28 hours, 95% CI —22.04 to —10.53, p < 0.00001), shorter time to first fluid intake (WMD: —89.96 hours, 95% CI —119.89 to —60.03, p < 0.00001) and solid food tolerance (WMD: —1.91, 95% CI –2.34 to —1.48, p < 0.00001) as compared to a traditional care group. The number of readmissions was lesser in the traditional care group as compared to the ERAS group (OR: 1.09, 95% CI 0.78 to 1.51, p = 0.74). The number of total complications was lower in the ERAS care group as compared to the traditional care group (OR: 0.49, 95% CI 0.36 to 0.66, p = 0.0003).
CONCLUSIONS Our results prove that ERAS is comparatively a better choice of surgical care protocol than conventional care, for patients who undergo colorectal surgery.