The impact of ERAS protocols on postoperative outcomes in robotic, laparoscopic, and open colorectal surgery: A multicenter retrospective study

Abstract

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols improve outcomes in colorectal surgery, but the impact of ERAS on comparative effectiveness across robotic, laparoscopic, and open approaches is unclear. METHODS: In this multicenter retrospective study, 5503 patients undergoing elective colorectal surgery from 13 centers could be included. Patients were compared regarding surgical technique and ERAS adherence. Primary outcomes included postoperative complications and anastomotic leakage; secondary outcomes included length of hospital stay (LOS) and Comprehensive Complication Index (CCI). Multivariate regression assessed ERAS impact. RESULTS: ERAS was used in 890 patients and associated with significantly shorter LOS across all modalities (robotic: 5.5 vs. 8.5 days; laparoscopic: 8.5 vs. 9.0 days; open: 13.1 vs. 14.5 days; p ​≤ ​0.02). ERAS independently reduced complication rates (p ​= ​0.016) and anastomotic leaks (p ​= ​0.007). Robotic surgery was protective against complications and linked to the greatest LOS reduction. ERAS did not significantly affect CCI. CONCLUSIONS: ERAS protocols improve postoperative outcomes across colorectal surgical techniques, with the greatest benefits in robotic surgery, supporting their broad clinical implementation.