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 .
Discharge within 24 to 72 hours of colorectal surgery is associated with low readmission rates when using Enhanced Recovery Pathways.
BACKGROUND Enhanced Recovery Pathways ( ERPs ) have demonstrated reduced hospital length of stay and improved outcomes after colorectal surgery . Concerns exist about increases in readmission rates . Laparoscopic colorectal surgery with an ERP can permit earlier discharge without compromising safety or increasing readmission rates . STUDY DESIGN A review of a prospect i ve data base was performed for major elective colorectal procedures by a single surgeon . All patients followed a st and ardized ERP and discharge criteria . Patients were categorized by approach and day of discharge ( DoD ) of ≤ 1 , ≤ 2 , ≤ 3 , ≤ 7 , and > 7 days . Main outcomes measures were length of stay and 30-day readmission rates in each group . RESULTS Eight hundred and six cases ( 609 laparoscopic , 197 open ) were identified during a 64-month period . Mean age was similar for the laparoscopic ( 59.1 years ) and open ( 58.3 years ) groups . Mean overall DoD was at 5 days ( ± 4.8 days ) ; by approach , the mean laparoscopic DoD was at 3.9 days and open DoD was at 8.4 days . Twenty-nine percent were discharged within 48 hours ( 38 % laparoscopic and 8 % open ) and 50 % were discharged within 72 hours ( 62 % laparoscopic and 19 % open ) . Only 8.9 % of all patients ( n = 72 ) were readmitted ( 7.2 % laparoscopic , 14.2 % open ) . The cumulative readmission rate for laparoscopic patients in early DoD groups postoperative days 1 , 2 , and 3 were 0.2 % , 1.6 % , and 3.4 % , respectively . CONCLUSIONS Combining laparoscopy with an ERP optimizes patient care in colorectal surgery . The combination permits early discharge ; 38 % were discharged within 2 days and 62 % within 3 days of surgery , with low readmission rates . These results support that early DoD is possible without compromising patient safety or increasing readmission rates . This might be a marker for low readmission rate , and suggests that readmission rate alone might not be an adequate marker of quality
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 .