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 .
Cost-effectiveness of Laparoscopy in Rectal Cancer
BACKGROUND : There is an increasing trend to use laparoscopy for rectal cancer surgery . Although laparoscopic and open rectal resections appear oncologically equivalent , there is little information on the cost of different surgical approaches . With the current health care crisis and the importance of optimizing health care re sources and patient outcomes , the cost of care is an important factor . OBJECTIVE : The aim of this study was to evaluate the cost-effectiveness of laparoscopy in rectal cancer . DESIGN : This was a case-matched study . SETTING S : This study was conducted at a tertiary referral center . PATIENTS : Patients undergoing elective rectal cancer resection between 2007 and 2012 were selected . METHODS : A review of a prospect i ve data base for  elective laparoscopic rectal cancer resections  was performed . Laparoscopic cases were matched to open cases based on age , BMI , operative procedure , and diagnostic-related group . MAIN OUTCOME MEASURES : The primary outcomes measured were the cost of care , hospital length of stay , discharge disposition , readmission , postoperative complications , and mortality rates . RESULTS : Two hundred fifty-four matched cases were included in the analysis : 125 laparoscopic ( 49 % ) and 129 open ( 51 % ) . The cTNM stage ( p = 0.39 ) , tumor distance from the anal verge ( p = 0.07 ) , and rate of neoadjuvant therapy received between the laparoscopic and open groups were similar ( p = 0.12 ) . Operating time ( p < 0.01 ) and cost per operating room minute ( p = 0.04 ) were significantly higher in the open group . The groups were oncologically equivalent , based on circumferential resection margin ( p = 0.15 ) . The laparoscopic group had a significantly shorter length of stay ( p < 0.01 ) and lower total hospital cost ( p < 0.01 ) . Postoperative complications , 30-day readmission , reoperation , and mortality rates were similar . However , significantly more patients undergoing open resection required intensive care unit care ( p = 0.03 ) , skilled nursing ( p = 0.03 ) , or home care services ( p < 0.01 ) at discharge . LIMITATIONS : This investigation was conducted at a single institution and it is a retrospective study with potential bias . CONCLUSIONS : Laparoscopy is cost-effective for rectal cancer surgery , improving both health care expenditures and patient outcomes . For selected patients , laparoscopic rectal cancer resection can reduce length of stay , operating time , and re source utilization
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 .