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 .
Enhanced recovery in major colorectal surgery: safety and efficacy in an unselected surgical population at a UK district general hospital.
BACKGROUND Enhanced Recovery Programmes ( ERPs ) have been shown to benefit recovery following major surgery in selected centres and patient groups , but their wider applicability requires continued evaluation . The aims of this study were to assess the outcomes of the first 400 consecutive , non-selected patients , undergoing major elective colorectal surgery within an Enhanced Recovery programme at a UK District General hospital and to examine the effects of patient risk factors and operative approach on outcomes . METHODS Since September 2005 all patients undergoing major elective colon and rectal surgery at our hospital have been treated within an ERP and their data recorded prospect ively on a data base . Safety and efficacy outcomes for the first 400 patients were compared using SPSS v14.0 with both a retrospective , pre-ERP group ; and according to patient risk factors and operative approaches . RESULTS Median length of stays ( LOS ) reduced from 9 days ( IQR 7 - 11 ) to 6 days ( IQR 5 - 10 ) after introduction of the ERP ( p < 0.001 ) . No statistically significant differences in LOS were observed between elderly ( ≥80 years ) and younger patients or between different BMI groups . American Society of Anesthesiologists ( ASA ) grade 3 patients demonstrated significantly longer median LOS than those with ASA grade s 1 and 2 . Patients undergoing laparoscopic surgery  had median LOS of 6 days ( IQR 4 - 8 ) compared to 7 days ( IQR 5 - 10 ) for open procedures ( p < 0.001 ) . No differences in morbidity or mortality were observed between the groups . CONCLUSIONS Unselected application of an ERP in our unit has been associated with reductions in post-operative LOS . The ERP was safe and effective when applied to all our study patients independent of age and BMI . Despite LOS being longer in ASA grade 3 patients , application of the ERP to this higher risk group was not associated with significantly increased morbidity or mortality . Laparoscopic surgery result ed in additional modest reductions in LOS compared to open surgery within the ERP
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 .