Surgical Endoscopy

, Volume 26, Issue 2, pp 442–450 | Cite as

Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay

  • Mary-Anne AartsEmail author
  • Allan Okrainec
  • Amy Glicksman
  • Emily Pearsall
  • J. Charles Victor
  • Robin S. McLeod



The objective of enhanced recovery after surgery (ERAS) programs is to incorporate strategies into the perioperative care plan to decrease complications, hasten recovery, and shorten hospital stay. This study was designed to determine which ERAS strategies contribute to overall shortened length of hospital stay in patients undergoing elective colorectal surgery in hospitals.


A retrospective cohort study of 336 consecutive patients at seven hospitals was performed. Demographic and data on 18 ERAS components identified from a systematic review of the literature were collected. A multiregression analysis was performed to assess for factors independently associated with a total length of hospital stay of 5 days or less.


Fifty-five percent were male (mean age, 62 years), 57.5% had an ASA III or IV, 76.9% had cancer, and 28.6% had low rectal procedures; 46.3% were completed laparoscopically. The median length of stay was 6.5 days with a mean of 8.6 days. On bivariate analysis, strategies associated with a stay ≤5 days were preoperative counseling, avoidance of oral bowel preparation, use of a laparoscopic approach, use of a transverse incision, introduction of clear fluids on day of surgery, and early discontinuation of the Foley catheter (all P < 0.05). On multivariate analysis, factors that remained significantly associated with a stay ≤5 days included use of a laparoscopic approach (odds ratio (OR), 1.24; 95% confidence interval (CI), 1.12–1.38), preoperative counseling (OR, 1.26; 95% CI, 1.15–1.38), intraoperative fluid restriction (OR, 1.26; 95% CI, 1.15–1.37), clear fluids on day of surgery (OR, 1.09; 95% CI, 1.00–1.2), and Foley urinal catheter discontinued within 24 h of colon surgery and 72 h of rectal surgery (OR, 1.13; 95% CI, 1.01–1.27).


In hospitals with variable uptake of ERAS strategies, preoperative counseling, intraoperative fluid restriction, use of a laparoscopic approach, immediate initiation of clear fluids after surgery, and early discontinuation of the Foley catheter are all independently associated with shortened length of stay.


Enhanced recovery after surgery Colorectal surgery Fast-track surgery 



Supported by a grant from Colon Cancer, Canada.


Drs. Aarts, Okrainec, and McLeod, along with authors Emily Pearsall, Amy Glicksman, and J. Charles Victor, have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Mary-Anne Aarts
    • 1
    • 2
    Email author
  • Allan Okrainec
    • 1
    • 6
  • Amy Glicksman
    • 1
  • Emily Pearsall
    • 1
  • J. Charles Victor
    • 7
  • Robin S. McLeod
    • 1
    • 3
    • 4
    • 5
    • 8
  1. 1.Department of SurgeryUniversity of TorontoTorontoCanada
  2. 2.Toronto East General HospitalTorontoCanada
  3. 3.Department of Health PolicyManagement, and Evaluation, University of TorontoTorontoCanada
  4. 4.Zane Cohen Digestive Diseases Research Center, Mount Sinai HospitalTorontoCanada
  5. 5.Samuel Lunenfeld Research Institute, Mount Sinai HospitalTorontoCanada
  6. 6.Toronto Western Hospital, University Health NetworkTorontoCanada
  7. 7.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  8. 8.DeGasparis Families Chair in IBD and GI Cancer ResearchTorontoCanada

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