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 .
Using Frailty to Predict Who Will Fail Early Discharge After Laparoscopic Colorectal Surgery With an Established Recovery Pathway
BACKGROUND : Despite laparoscopy and enhanced recovery pathways , some patients do not attain early discharge . Frailty is generally accepted as a marker of increased risk , complications , and mortality . Frailty may have the potential to identify patient outcomes . PURPOSE : The aim of this study was to evaluate frailty as a predictor of patients who might fail early discharge . SETTING : This study was conducted at a tertiary referral center . DESIGN : This was a case-matched study . PATIENTS : Elective abdominal laparoscopic colorectal cases from 2009 to 2012 were selected . METHODS : Review of a prospect i ve data base matched all cases with a postoperative day of discharge of ⩽3 days to a > 3 day of discharge cohort . All patients followed a st and ardized enhanced recovery  pathway . STATISTICAL ANALYSIS : Categorical and ordinal variables were analyzed with the Student t test or Fisher exact test , and correspondence analysis evaluated the relationship between length of stay and the Modified Frailty Index . MAIN OUTCOME MEASURE : The primary outcome measure was the relationship between length of stay and the Modified Frailty Index . RESULTS : There were 464 ⩽3 day and 388 > 3 day patients . The groups were similar in demographics and comorbidities . There were significant differences in the Modified Frailty Index ( p < 0.01 ) , operative time ( p < 0.01 ) , postoperative complications ( p < 0.01 ) , 30-day readmissions ( p = 0.03 ) , and 30-day reoperation rate ( p < 0.01 ) . Significantly more patients were discharged home in the ⩽3 day cohort . Correspondence analysis demonstrated a higher Modified Frailty Index was indicative of longer length of stay . A Modified Frailty Index of 0 was strongly related to a length of stay 0 to 3 days , and a Modified Frailty Index of 2 was strongly related to a 8- to 14-day stay . LIMITATIONS This was a single-center study performed on a retrospective data set . CONCLUSIONS : Patients undergoing elective colorectal surgery with a higher Modified Frailty Index were more likely not to attain early discharge . Despite similar demographics , the Modified Frailty Index could discriminate between patient outcomes , and correlated with longer operating times , length of stay , and readmissions . By using a prospect i ve score to identify patients at risk for not achieving early discharge preoperatively , re sources and postoperative support can be better allocated
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 .