Reliability of Simplified Versions of Enhanced Recovery After Surgery (ERAS) in Colorectal Surgery: A Retrospective Cohort Study

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Introduction Enhanced recovery after surgery (ERAS) programs have transformed perioperative care. However, adherence to all ERAS components can be challenging, and the contribution of individual components remains uncertain. This study evaluates ERAS compliance and compares its predictive accuracy with four simplified protocols: a) remove, ambulate, postoperative analgesia, introduce diet (RAPID), b) Basse, c) Nygren, and d) Aarts in colorectal cancer surgery. Methods A retrospective cohort study was conducted at Vila Santa Catarina Hospital (São Paulo, Brazil) and included patients undergoing elective colorectal resection for adenocarcinoma (2015-2022). ERAS compliance was measured by adherence to 22 components and compared with four simplified protocols (elements four to 12). Outcomes analyzed included stoma-free status, avoidance of readmission, absence of overall and severe complications, and mortality. Predictive accuracy was assessed via area under the curve (AUC) from receiver operating characteristic (ROC) curves (p<0.05). Results The study included 410 patients (mean age: 62.3 ±11.5 years; 53.4% female). Laparoscopic surgery was predominant (90%), followed by robotic (6.3%) and open (3.7%) approaches. Mean ERAS compliance was 76.9% (±9%). Postoperative outcomes were 66.3% stoma-free, 92.7% avoided readmission, 68.5% had no complications, 85.9% had no severe complications, and 98.1% survived. ERAS had the highest predictive value for severe complications (AUC: 0.69), similar to Nygren (0.68). Nygren outperformed ERAS for stoma-free (0.7 vs. 0.66) and complications (0.63 vs. 0.62). ERAS had low accuracy for readmission avoidance (AUC: 0.51), with RAPID and Basse performing better. No protocol showed significant superiority in predicting mortality (p>0.05). Conclusions Simplified protocols, especially Nygren and RAPID, showed competitive or superior predictive performance for certain outcomes. While ERAS remains a strong standard, simplified versions appear promising.

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