The readmission rate as a game changer: from early to right discharge after colorectal surgery: 15 years of experience from an Enhanced Recovery After Surgery-certified center

Background: Enhanced Recovery After Surgery (ERAS) protocols in colorectal surgery optimize postoperative recovery and enable early discharge. Readmission rates are key indicators of healthcare quality, reflecting the adequacy of initial hospitalization and follow-up care. Method: This retrospective clinical audit analyzed a prospective database of 1427 patients undergoing elective colorectal resections under ERAS protocols from January 2008 to December 2022 at a single center. Patients were operated on under the leadership of a single chief surgeon, with progressive adherence to ERAS culminating in certification as a qualified ERAS center in 2021. Exclusions included emergency and palliative surgeries. Logistic regression was used to analyze predictors of 30-day readmission, with complications categorized using the Clavien–Dindo classification. Results: The median age was 70 years, and 34.6% of patients were classified as American Society of Anesthesiologists III–IV. The 30-day readmission rate was 7.6% (109 patients), with over half due to minor complications (Clavien–Dindo I–II). Independent predictors of readmission included chronic ischemic heart disease, diabetes, rectal resections, extended right colectomies, abdominoperineal excision, and splenic flexure resections. Progressive adherence to ERAS reduced median hospital stay from 4 to 2 days without significantly increasing readmission rates. Conclusion: This 15-year audit confirms that discharge under ERAS criteria is safe and should be considered “optimal” rather than “early.” Targeted postdischarge strategies for high-risk patients and structured follow-up could further reduce unnecessary readmissions, especially for minor complications, improving recovery and healthcare resource utilization in colorectal surgery.