Implementing a multidisciplinary perioperative pathway in a public hospital: First-year outcomes and lessons from real-world practice

Background Multidisciplinary perioperative pathways are associated with improved outcomes in colorectal surgery, but evidence on real-world implementation is still scarce, especially in limited-resource settings. Methods: An audit was conducted targeting first-year outcomes after implementation of the Optimised Recovery Programme in Colorectal Surgery at a tertiary public hospital since February 2024. Results were compared with a historical pre-implementation cohort treated in 2022. Outcomes and quality indicators were analysed using descriptive statistics. Results: Despite a higher proportion of patients with severe systemic disease in the optimised recovery cohort, mean hospital length of stay decreased substantially, as well as readmission rates, with no increase in 30-day mortality. Conclusions: Real-world implementation of a multidisciplinary perioperative pathway was feasible and safe, even in a high comorbidity population and limited-resource setting. These findings support the value of structured perioperative systems of care and multidisciplinary coordination in routine clinical practice.