Comparison of Conventional and Enhanced Recovery after Surgery Protocols in Emergency Colorectal Surgery: A Prospective Comparative Study from a Tertiary Care Center

A BSTRACT Background: Emergency colorectal surgery is associated with high morbidity and prolonged hospital stay due to adverse physiological conditions at presentation. Enhanced recovery after surgery (ERAS) protocols improve outcomes in elective colorectal surgery; however, evidence supporting their application in emergency settings remains limited, particularly in low- and middle-income countries. Materials and Methods: This prospective comparative cohort study was conducted over 12 months at a hospital, including 34 patients undergoing emergency colorectal surgery. Seventeen patients were managed using an adapted ERAS protocol and 17 received conventional perioperative care. The ERAS protocol emphasized early mobilization, early oral feeding, multimodal opioid-sparing analgesia, restricted intravenous fluids, and early removal of tubes and catheters. The primary outcome was length of hospital stay, with secondary outcomes including recovery parameters, pain scores, and postoperative complications. Results: Baseline demographic and clinical characteristics were comparable between the groups. The ERAS group demonstrated significantly shorter hospital stay (5.6 ± 1.4 vs. 9.8 ± 2.7 days; P < 0.001), earlier return of bowel function (2.2 ± 0.7 vs. 4.1 ± 1.2 days; P < 0.001), earlier initiation of oral feeding (1.8 ± 0.6 vs. 3.6 ± 1.1 days; P < 0.001), and lower 24-h Visual Analog Scale pain scores (2.3 ± 0.8 vs. 4.9 ± 1.3; P < 0.001). Minor postoperative complications were fewer in the ERAS group, with no increase in major morbidity, anastomotic leak, or mortality. Conclusion: Adapted ERAS protocols are safe, feasible, and effective in emergency colorectal surgery, resulting in faster recovery, reduced hospital stay, and lower postoperative morbidity without compromising patient safety.