PhD Scientific Days 2026

Surgical Medicine

Effect of High Compliance to Enhanced Recovery After Surgery Protocol on Postoperative Outcomes

Name of the presenter

Szilágyi, Eszter Szabina

Institute/workplace of the presenter

Department of Surgery, Transplantation and Gastroenterology

Authors

Szilágyi Eszter Szabina¹, Bánky Balázs¹, Szijártó Attila¹, Fülöp András¹
1: Department of Surgery, Transplantation and Gastroenterology

Text of the abstract

Introduction:
Major abdominal surgery is associated with significant physiological stress, which remains a key contributor to postoperative morbidity. Enhanced Recovery After Surgery (ERAS) programs improve outcomes in colorectal surgery, yet their implementation in resource-limited settings remains challenging. Although a compliance threshold of 70–75% has been proposed, evidence beyond this level is limited.
Aims:
Our study aimed to evaluate achievable ERAS compliance, its association with clinical outcomes, and feasibility of implementation in a financially constrained healthcare system.
Methods:
A prospective single-center cohort study was conducted between 2022 and 2024, including patients undergoing elective colorectal surgery. ERAS compliance was assessed with 20 perioperative elements and expressed as a percentage. Patients were stratified into six groups based on compliance rate (<75% and in 5% increments above this threshold). Outcomes included length of stay (LOS), intensive care unit (ICU) utilization, postoperative complications, readmission, and mortality.
Results:
A total of 338 patients were analysed. The mean age was 63.4 years, and 37.9% were women. The mean compliance was 89.3%, with 70% of patients exceeding 85%. The meadian LOS was 6 days (IQR 5-7), while readmission within 30 days was 5.3%. ICU admission occured in 23.7%, where patients spent a median of 1 day (IQR 1-2.5). Overall morbidity occured in 28.1%, with minor and major morbidity in 21.0% and 9.2%, respectively. Early (1-7 days) complications occured in 16.9%, while late (8-30 days) complications occured in 15.4%. Higher compliance was associated with significantly reduced LOS (p<0.001), ICU admission and duration (p<0.001), and early postoperative complications (p<0.001). Overall morbidity showed a weak negative correlation with compliance (R= −0.12, p=0.03). Each 5% increase in compliance resulted in a 3% shorter LOS and 22% lower odds of early complications.
Conclusion:
High ERAS compliance is achievable in resource-limited settings through structured audit systems. Clinical outcomes improve progressively beyond the previously accepted 75% threshold, supporting the goal of near-complete adherence.
Funding: No external funding was received for this study.