International Journal of Colorectal Disease

, Volume 33, Issue 11, pp 1543–1550 | Cite as

ERAS protocol validation in a propensity-matched cohort of patients undergoing colorectal surgery

  • Riccardo Lemini
  • Aaron C. Spaulding
  • James M. Naessens
  • Zhuo Li
  • Amit Merchea
  • Julia E. Crook
  • David W. Larson
  • Dorin T. ColibaseanuEmail author
Original Article



Enhanced recovery after surgery (ERAS) provides many benefits. However, important knowledge gaps with respect to specific components of enhanced recovery after surgery remain because of limited validation data. The aim of the study was to validate a mature ERAS protocol at a different hospital and in a similar population of patients.


This is a retrospective analysis of patients undergoing elective colorectal surgery from 2009 through 2016. Patients enrolled in ERAS are compared with those undergoing the standard of care. Patient demographic characteristics, length of stay, pain scores, and perioperative morbidity are described.


Patients (1396) were propensity matched into two equal groups (ERAS vs non-ERAS). No significant difference was observed for age, Charlson Comorbidity Index, American Society of Anesthesiologists score, body mass index, sex, operative approach, and surgery duration. Median length of stay in ERAS and non-ERAS groups was 3 and 5 days (P < .001). Mean pain scores were lower in the ERAS group, measured at discharge from the postanesthesia unit (P < .001), on postoperative day 1 (P = .002) and postoperative day 2 (P = .02) but were identical on discharge.


This ERAS protocol was validated in a similar patient population but at a different hospital. ERAS implementation was associated with an improved length of stay and pain scores similar to the original study. Different than most retrospective studies, propensity score matching ensured that groups were evenly matched. To our knowledge, this study is the only ERAS validation study in a propensity-matched cohort of patients undergoing elective colorectal surgery.


Colorectal surgery Propensity score Patient readmission Pain management Patient discharge 


Authors’ Contributions

All authors made substantial contribution to the conception and design of the work, as well as the acquisition, analysis, and interpretation of data. All authors were critically involved in drafting and revising this project for important intellectual content. Final approval of the version to be published was given by all authors, and they agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Source of funding

Funding provided by Robert D. and Patricia E. Kern Center for Science of Health Care Delivery. The funder had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Compliance with ethical standards

The Mayo Clinic Institutional Review Board approved this retrospective study. This study followed the reporting guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Riccardo Lemini
    • 1
  • Aaron C. Spaulding
    • 2
  • James M. Naessens
    • 2
  • Zhuo Li
    • 3
  • Amit Merchea
    • 1
  • Julia E. Crook
    • 3
  • David W. Larson
    • 4
  • Dorin T. Colibaseanu
    • 1
    • 3
    Email author
  1. 1.Section of Colon and Rectal Surgery, Mayo ClinicJacksonvilleUSA
  2. 2.Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo ClinicJacksonvilleUSA
  3. 3.Department of Health Sciences Research, Biostatistics Unit, Mayo ClinicJacksonvilleUSA
  4. 4.Division of Colon and Rectal Surgery, Mayo ClinicRochesterUSA

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