Association between ERAS compliance and postoperative outcomes after right colectomy for colon cancer: a single-center cohort study

Enhanced Recovery After Surgery (ERAS) protocols improve perioperative care in colorectal surgery; however, evidence specifically linking ERAS compliance to outcomes after right colectomy is limited. This study aimed to evaluate the association between overall and phase-specific ERAS compliance and postoperative outcomes after elective right colectomy for colon cancer. This retrospective analysis of a prospectively maintained institutional ERAS database included consecutive adults who underwent elective standard or extended right colectomy for colon cancer between January 2021 and December 2025. Compliance was assessed at the patient level using 24 predefined ERAS elements across pre-admission, preoperative, intraoperative, and postoperative phases. The primary outcome was length of stay (LOS), and the secondary outcome was major postoperative complications (Clavien–Dindo grade ≥IIIa). Correlation analyses, group comparisons using a prespecified 75% overall compliance threshold, and multivariable logistic and linear regression analyses were performed. Among 151 included patients, 76 (50.3%) developed any postoperative complication, 14 (9.3%) had major postoperative complications, and 10 (6.6%) were readmitted within 30 days. Overall ERAS compliance was inversely correlated with LOS (ρ = −0.329, p < 0.001). Preoperative (ρ = −0.248, p = 0.002) and postoperative (ρ = −0.301, p < 0.001) phase-specific compliance were also associated with shorter LOS. Patients with overall compliance ≥ 75% had shorter LOS than those with lower compliance, whereas major complication rates were similar. In exploratory multivariable analysis, higher preoperative compliance was independently associated with lower odds of major postoperative complications (OR 0.936, 95% CI 0.884–0.991; p = 0.024). Older age (B = 0.183, p = 0.022) and lower overall compliance (B = -0.265, p = 0.006) were independently associated with longer LOS. Higher ERAS compliance was associated with shorter length of stay, though the contribution of postoperative compliance may partly reflect recovery status rather than an independent causal effect. Higher preoperative adherence was independently associated with lower odds of major complications in exploratory multivariable analysis. These findings support strengthening preoperative optimization and consistent pathway execution to improve recovery after right colectomy.