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 .
Fast-track colorectal surgery: protocol adherence influences postoperative outcomes
Purpose This single-center prospect i ve cohort study , conducted outside of a clinical trial , tried to identify the importance of each fast-track surgery procedure and protocol adherence level on clinical outcomes after colorectal surgery . Methods From a prospect ively maintained data base , 606 patients who underwent elective laparoscopic or open colorectal resection within a well established fast-track surgery ( FT ) protocol , between 2005 and 2011 , were identified . Univariate and multivariate analysis were performed to assess the relationship between each FT procedure with an adherence rate < 100 % and the outcome variables ( length of stay — LOS , 30-day morbidity and readmission rate ) . Patients were divided into four adherence level groups to FT procedures —100 % , 85–95 % , 70–80 % , and < 65 % . Each adherence group was compared with the other groups to evaluate differences in clinical outcome variables . Results Group comparisons revealed that higher levels of FT protocol adherence corresponded to significantly improved LOS and morbidity rates . Readmission rates were only significantly different between the full fast-track pathway and the less implemented groups . Multivariate analyses revealed that the fast removal of bladder catheter positively influenced length of stay ( p < 0.0001 ) and 30-day morbidity ( p < 0.0001 ) . Laparoscopy surgery , no drain positioning and enforced mobilization improved LOS ( p = 0.027 , p < 0.0001 , p = 0.002 , respectively ) . Early solid feeding improved LOS ( p < 0.0001 ) , morbidity ( p < 0.0001 ) and readmission rate ( p = 0.011 ) . Conclusion Postoperative outcomes after colorectal surgery are directly proportional to FT protocol adherence . The early removal of the bladder catheter and early postoperative solid feeding independently influenced the length of hospital stay and 30-day morbidity rates
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 .