Key result
Higher Charlson Comorbidity Index is linked to ~41% lower adequate postoperative ERAS adherence.
Why the study?
Achieving at least 75% adherence to ERAS principles is needed for good outcomes after colorectal surgery but is challenging postoperatively, prompting evaluation of the Charlson Comorbidity Index to predict adherence.
Does a higher Charlson Comorbidity Index predict failure to achieve adequate postoperative ERAS adherence in patients undergoing colorectal surgery?
Cohort (n=572)
No
Does a higher Charlson Comorbidity Index predict failure to achieve adequate postoperative ERAS adherence in patients undergoing colorectal surgery?
Absolute Event Rate: 42.5% vs 72.6%
p-value: p=<0.001
A higher Charlson Comorbidity Index (≥ 2) is an independent predictor of failure to achieve adequate postoperative ERAS adherence in colorectal surgery patients.
Higher CCI predicts lower ERAS adherence, more complications, and longer stays; leaves open whether CCI-stratified protocols improve outcomes.
INTRODUCTION: Enhanced recovery after surgery (ERAS) is a widely accepted program aimed at improving short-term outcomes in patients undergoing colorectal surgery. To achieve good postoperative outcomes, adherence of at least 75% to ERAS principles is required, which is particularly challenging during the postoperative period. METHODS: Patients undergoing colorectal resection between May 2016 and October 2022 were prospectively enrolled in the ERAS protocol and stratified according to the retrospectively assessed CCI. Patients with ≥ 5% missing data were excluded. The primary outcome was to evaluate the predictive value of the Charlson Comorbidity Index (CCI) for achieving adequate postoperative ERAS adherence (≥ 75%). RESULTS: A total of 572 patients were included (CCI 0: 223 [39.0%], CCI 1: 41 [7.2%], CCI 2: 150 [26.2%], CCI 3: 71 [12.4%], CCI ≥ 4: 87 [15.2%]). Patients with a CCI score of 0 had a median postoperative ERAS adherence of 84.6% (range: 15.4-100) compared with 69.2% (range: 16.7-100) in patients with a CCI score of ≥ 4 (p < 0.001). Increasing CCI was significantly associated with a higher complication index (p < 0.001) and a longer length of hospitalization stay (p < 0.001). In the multivariate analysis, CCI ≥ 2 was an independent predictor of failure to achieve adequate postoperative ERAS adherence (≥ 75%). CONCLUSION: Higher CCI was associated with lower postoperative ERAS adherence. Based on these findings, an exploratory risk-stratification algorithm is proposed to facilitate the preoperative identification of patients at increased risk for inadequate postoperative ERAS adherence.
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Cathomas et al. (2026) conducted a cohort in Colorectal surgery (n=572). Higher Charlson Comorbidity Index (CCI ≥ 4) vs. Lower Charlson Comorbidity Index (CCI 0) was evaluated on Adequate postoperative ERAS adherence (≥75%) (p=<0.001). A higher Charlson Comorbidity Index was significantly associated with lower postoperative ERAS adherence, with adequate adherence achieved in only 42.5% of patients with a score ≥4 compared to 72.6% of patients with a score of 0.
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