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Session: ePoster: Quality and Cost 1 (Sun8)

EP350 - Comparison between Enhanced Recovery After Surgery (ERAS) versus non-ERAS Protocol Elective Colorectal Surgery Patients in a Philippine Tertiary Hospital

Sunday, May 11, 2025
8:16 AM – 8:21 AM PT
Location: Monitor 9, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • IG

    Ina Gabrielle Gutierrez, Physician (she/her/hers)

    Surgery Resident
    Makati Medical Center
    Paranaque, National Capital Region, Philippines

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • MO

    Mark Augustine S. Onglao, MD, FPSCRS

    Consultant
    Philippine General Hospital, University of the Philippines Manila
    Makati, National Capital Region, Philippines

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Ina Gabrielle Gutierrez, Physician: This individual has no financial relationships with ineligible companies.
Mark Augustine S. Onglao, MD, FPSCRS: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: First introduced in 1997 by Henrik Kehlet in Europe, the Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, evidence-based approach to surgical care aimed at optimizing the perioperative experience for patients. ERAS protocols are designed to accelerate recovery, reduce complications, shorten hospital stays, and improve overall surgical outcomes.
ERAS has been widely implemented for over two decades in the west. In the Philippines, the first ERAS Center of Excellence was established as early as 2014. However, its principles have yet to achieve widespread acceptance. At Makati Medical Center, the ERAS protocol was only introduced by the Section of Colorectal Surgery in 2021, and its adoption remains limited.
This study aims to evaluate the initial outcomes of implementing an ERAS protocol for patients undergoing elective colorectal surgery at our institution.

Methods/Interventions: A retrospective cohort study design was employed for this research. Data was collected from January to December 2023. The inclusion criteria encompassed adult patients (18 years and older) undergoing elective colorectal surgery at a Philippine tertiary hospital, regardless of the surgical approach (open or laparoscopic) or procedure type (right-sided or left-sided colon resection, rectal resection, and stoma closure). Patients were categorized into two groups: those enrolled in ERAS protocols and those managed under non-ERAS protocols.

Compliance with the following ERAS elements was assessed:
Preoperative: bowel preparation, carbohydrate loading, preoperative antibiotics, and venous thromboembolism prophylaxis.
Intraoperative: multimodal anesthesia (if applicable), avoidance of long-acting opioids, avoidance of drains, and avoidance of nasogastric tubes.
Postoperative: early removal of Foley catheters, minimization of intravenous fluids, nausea and vomiting prophylaxis, early diet progression, ileus prophylaxis, and early mobilization.
The outcomes evaluated included length of hospital stay, ICU admission, anastomotic leak, complications, mortality, readmission, and reoperation.

Results/Outcomes: While some ERAS elements were implemented in the non-ERAS group, compliance with specific elements such as carbohydrate loading and the application of TED stockings preoperatively, avoidance of epidural use and Jackson-Pratt drains intraoperatively, early Foley catheter removal, ileus prophylaxis, and day 0 diet progression postoperatively was significantly higher in the ERAS group.
The overall compliance rate for all ERAS elements was 87.9% in the ERAS group compared to 57.7% in the non-ERAS group. Patients in the ERAS group had a significantly shorter postoperative length of stay (4 versus 6 days), with no differences observed in ICU admissions, anastomotic leaks, complications, mortality, readmissions, or reoperations.

Conclusion/Discussion: This study reaffirms that compliance with the ERAS protocol in elective colorectal surgery significantly shortens hospital stay without compromising patient outcomes. These findings will serve as a foundation for further expansion of ERAS protocol implementation across various subspecialties at our institution, beyond colorectal surgery.