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Session: ePoster: Quality and Cost 4 (Mon8)

EP654 - Enhanced Recovery After Surgery (ERAS) for Emergency Colorectal Surgery: A Meta-analysis

Monday, May 12, 2025
8:38 AM – 8:43 AM PT
Location: Monitor 7, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Nikko H. Cabrestante (he/him/his)

    General Surgery Resident
    Philippine General Hospital
    Manila, National Capital Region, Philippines

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

    • Author(s)

  • ML

    Marc Paul J. Lopez, MD, FPSCRS, FPCS

    President
    Philippine Association of Colon and Rectal Surgeons
    Manila, National Capital Region, Philippines

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

  • 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.

  • Sofia Isabel T. Manlubatan

    Medical Officer IV
    Philippine General Hospital
    Philippine General Hospital
    Manila, National Capital Region, Philippines

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

  • gc

    gwyn p. celo, Diplomate, philippine board of surgery

    medical officer IV
    Division of colorectal surgery, UP-Philippine General Hospital
    iloilo city, Iloilo, Philippines

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

  • Christopher Allu S. Sy, MD

    Resident
    Philippine General Hospital
    University of the Philippines Manila - Philippine General Hospital
    Manila City, National Capital Region, Philippines

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Nikko H. Cabrestante: This individual has no financial relationships with ineligible companies.
Marc Paul J. Lopez, MD, FPSCRS, FPCS: This individual has no financial relationships with ineligible companies.
Mark Augustine S. Onglao, MD, FPSCRS: This individual has no financial relationships with ineligible companies.
Sofia Isabel T. Manlubatan: This individual has no financial relationships with ineligible companies.
gwyn p. celo, Diplomate, philippine board of surgery: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Enhanced Recovery After Surgery (ERAS) is composed of standardized steps for perioperative care implemented by a multidisciplinary team to facilitate earlier recovery and return to function. There is robust evidence showing the benefit of ERAS in patients undergoing elective colorectal surgery. However, 20 to 30% of procedures to the colon and rectum require emergent surgical intervention, and are not enrolled to an ERAS program. Although not widely practiced, there is growing evidence that implementing principles of ERAS to non-elective intraabdominal surgeries is beneficial, in terms of decreasing hospital length of stay (LOS), and reducing postoperative complications. This meta-analysis aimed to explore the effects of employing an ERAS protocol in patients undergoing emergency colorectal surgery. ‎ ‎

Methods/Interventions: Studies published from 2014 to 2024 were systematically searched in MEDLINE, Cochrane Library, and Google Scholar. A separate manual web search for related literature was also done after the initial database search. Only analytical observational studies comparing the effect of ERAS with traditional perioperative care in adult patients who underwent emergency colorectal surgery were included. Key outcomes examined included: LOS, postoperative morbidity, readmission rate, reoperation rate, and mortality. Hospital LOS was analyzed using pooled mean differences, while the other outcomes via pooled risk ratio (RR) with 95% confidence intervals (CI) using a random-effects model. Results were graphically presented using a Forest plot. ‎

Results/Outcomes: Four prospective and two retrospective cohort studies with a total of 1396 participants (605 ERAS and 791 conventional perioperative care) were included. This meta-analysis showed significant decrease in LOS (mean reduction 3.23 days; 95% CI, − 4.44 to − 2.02), and risk of overall postoperative complications (RR = 0.82; 95% CI, 0.72 to 0.94) for patients who were enrolled to ERAS compared to those receiving conventional care. The implementation of ERAS was not associated with a significant decrease in 30-day readmission, 30-day reoperation, and 30-day mortality rates.

Conclusion/Discussion: This meta-analysis showed that ERAS protocols may reduce hospital LOS and decrease the risk of developing postoperative complications in patients undergoing emergency colorectal surgery. Most of the included studies, however, investigated only obstructive colorectal cancer. Further investigation to include other emergency colorectal cases (e.g. bowel perforation, bleeding) may be necessary, particularly those where septic complications may considerably affect the clinical course and outcome of patients. Since there is lack of a standard ERAS protocol for the emergency setting, each center implemented their own set of “modified ERAS” protocols with varying degrees of compliance, making it difficult to draw conclusion as to which components were the most beneficial.