Reduced protocol compliance was the most frequently identified modifiable predictive factor for adverse LOS , morbidity and readmission .
Conclusion Protocol compliance is the most frequently reported predictive factor for outcomes of ERAS programmes following laparoscopic colorectal resection .
Reduced compliance increases LOS , morbidity and readmission to hospital .
The impact of compliance with individual ERAS protocol elements is insufficiently studied , and the lack of a st and ardised framework for evaluating ERAS programmes makes it difficult to draw definite conclusions about which factors exert the greatest impact on outcome after laparoscopic colorectal resection
Objective To perform a systematic review of published literature for the factors reported to predict outcomes of enhanced recovery after surgery ( ERAS ) programmes following  laparoscopic colorectal surgery .
Background ERAS programmes and the use of laparoscopy have been widely adopted in colorectal surgery bringing short-term patient benefit .
However , there is a minority of patients that do not benefit from these strategies and their identification is not well characterised .
The factors that underpin outcomes from ERAS programmes for laparoscopic patients are not understood .
Increased Risk for Complications After Colorectal Surgery With Selective Cyclo-oxygenase 2 Inhibitor Etoricoxib
BACKGROUND : Cyclo-oxygenase 2 inhibitors can be used for pain treatment after colorectal surgery . OBJECTIVE : The aim of this study was to investigate whether the use of etoricoxib has negative effects on the perioperative outcome in colorectal surgery . DESIGN : Complication data from an advanced medical data base system were sample d prospect ively , and patient records were review ed retrospectively . PATIENTS : All patients with elective colorectal surgery within an enhanced recovery after surgery protocol from 2008 to 2009 were selected . INTERVENTION : The nonr and omized use of perioperative etoricoxib treatment was compared with a control group . MAIN OUTCOME MEASURES : The primary outcome measured was the number of patients with postoperative complications according to the Dindo-Clavien classification . RESULTS : One hundred one patients received etoricoxib treatment , whereas 104 did not . The patient groups were very comparable . We observed a significant increase in the number of patients with postoperative complications with etoricoxib treatment ( 43 vs 30 patients ; 42.6 % vs 28.8 % , p = 0.041 ) due to an increase in patients with a major complication ( Dindo-Clavien complication grade III – V : 22.8 % vs 9.6 % , p = 0.01 ) . Patients with etoricoxib treatment and a complication needed a longer recovery period than patients with a complication in the control group ( 18 ( 17 ; 20 ) vs 14 ( 13 ; 15 ) days , p = 0.05 ) . We observed an increased level of postoperative serum creatinine with etoricoxib treatment ( 105 ( 98 ; 112 ) vs 82 ( 78 ; 85 ) , p = 0.003 ) , which was more pronounced in patients with a complication ( 141 ( 127 ; 155 ) vs 91 ( 83 ; 98 ) , p = 0.002 ; 25 vs 8 patients with serum creatinine > 100 & mgr;mol/L , p = 0.008 ) . In multivariate analysis , etoricoxib was identified as an independent risk factor for experiencing a major complication with a risk increase of approximately 2.5-fold ( p = 0.03 ) . LIMITATIONS : This study was limited by the nonr and omized use of perioperative etoricoxib and the retrospective nature of its review of patient records . CONCLUSIONS : Etoricoxib increased the number of patients with postoperative complications and should be considered carefully in colorectal surgery
Reduced protocol compliance was the most frequently identified modifiable predictive factor for adverse LOS , morbidity and readmission .
Conclusion Protocol compliance is the most frequently reported predictive factor for outcomes of ERAS programmes following laparoscopic colorectal resection .
Reduced compliance increases LOS , morbidity and readmission to hospital .
The impact of compliance with individual ERAS protocol elements is insufficiently studied , and the lack of a st and ardised framework for evaluating ERAS programmes makes it difficult to draw definite conclusions about which factors exert the greatest impact on outcome after laparoscopic colorectal resection
Objective To perform a systematic review of published literature for the factors reported to predict outcomes of enhanced recovery after surgery ( ERAS ) programmes following  laparoscopic colorectal surgery .
Background ERAS programmes and the use of laparoscopy have been widely adopted in colorectal surgery bringing short-term patient benefit .
However , there is a minority of patients that do not benefit from these strategies and their identification is not well characterised .
The factors that underpin outcomes from ERAS programmes for laparoscopic patients are not understood .