Contemporary elective right hemicolectomy in Scotland: a National Enhanced Recovery Colorectal Initiative (NERCI) study

Background This study describes the introduction of a Scottish nationwide implementation programme to establish Enhanced Recovery After Surgery (ERAS) care following colorectal surgery. The National Enhanced Recovery Colorectal Initiative (NERCI) dataset is presented for right hemicolectomy, with Public Health Scotland records used to validate the results. Methods This was a national cross-sectional observational study of Scottish patients undergoing elective right hemicolectomy using two large orthogonal datasets: the NERCI database 2016–2024 and the Scottish Morbidity Records (SMR01) database coded from all inpatient episodes between 2010 and 2024. Results There were 12,853 elective right hemicolectomy operations recorded in the SMR01 database between 2010 and 2024. Prior to the introduction of NERCI (2010–2015) the median length of stay was 7 days compared with 5 days between 2016 and 2024. Between 2016 and 2024, there were 5342 right hemicolectomies recorded in the NERCI database compared with 7881 in the SMR01 database, indicating a 67.3% total case capture. Case capture was near complete for minimally invasive surgery procedures (considerably less so for open surgery ~28%), and annualised length of stay, mortality and 30-day readmission were strongly correlated between datasets. In the NERCI dataset, the majority of procedures were performed for cancer (87%) and laparoscopically (53.4%). The median length of stay was 5 days (IQR 4–8 days) and the anastomotic leak rate was 1.5% with a 90-day mortality of 1.4%. Overall, 72% of patients were ERAS bundle compliant (attaining at least three out of four compliance outcomes). Conclusions Following the introduction of a national programme to embed ERAS care in Scotland, improvements have been seen in recovery metrics following elective right hemicolectomy. What does this paper add to the literature? This study describes national implementation of an Enhanced Recovery After Surgery (ERAS) programme following colorectal surgery. Two large national datasets were evaluated (NERCI, SMR01). The NERCI dataset was near complete nationally and showed high ERAS compliance and low anastomotic leak and mortality rates, demonstrating excellent outcomes after elective right hemicolectomy in Scotland.