Abstract
ERAS has already been proven to reduce postoperative complication and length of hospital stay. However, in real practice, application may vary from center to center and not all can be applied equally. Accordingly, we sought to evaluate the role and importance of ERAS compliance through quality rather than the appropriateness of each individual item. In addition, the association between high compliance and postoperative complication was analyzed according to severity. Patients who underwent colon cancer surgery were divided into Phase I (before November 2019) and Phase II (from November 2019 to December 2022). Phase II included high risk patients over 65 years of age and with an ASA score more than 3, but there was no significant difference in compliance with Phase I (78.12 ± 11.70 vs. 76.92 ± 12.25%, P = 0.112). Total and minor complications significantly decreased, but major complications did not (25 [5.8%] vs. 26 [5.4%], P = 0.764). High compliance and Phase II were associated with lower complications and significantly reduced lengths of stay in all patients with complications; surgical stress-related inflammatory markers were significantly reduced. Although ERAS protocol compliance cannot prevent major surgery-related complications, high compliance enables earlier recovery and shorter hospital stays for patients with major complications by reducing surgical stress-related inflammatory responses.