Ambulatory Colorectal Surgery Following Enhanced Recovery After Surgery Guidelines: A Cohort Study of a Multidisciplinary Protocol

Aim: To evaluate the clinical outcomes of an ambulatory colorectal surgery protocol based on the enhanced recovery after surgery (ERAS) recommendations. Method: A retrospective observational cohort study was conducted involving adult patients who underwent major colorectal surgery under ERAS between 2022 and 2024. To qualify for ambulatory surgery, patients were required to undergo preoperative counseling, have family support, demonstrate medical adherence, and be classified as American Society of Anesthesiology (ASA) I or II. Patients who underwent complex procedures, required intensive care, or were considered at high social risk were excluded. The outcomes assessed included gastrointestinal recovery, complications, reinterventions, hospital readmissions, and length of stay exceeding 30 days. Results: A total of 114 patients were treated according to the institutional protocol, of whom 14.9% (17/114) were eligible for outpatient colorectal surgery. The median age was 60 years, and 82.4% (14/17) were men classified as ASA II who underwent anterior rectal resection or right hemicolectomy for primary adenocarcinoma. The median length of hospital stay was 19 hours [interquartile range (IQR): 15-21], with a median time to oral recovery of 6 hours (IQR: 4-6) and a median time to flatus passage of 10 hours (IQR: 6-11). There were no reinterventions or readmissions within 30 days postoperatively. Conclusion: Ambulatory colorectal surgery performed under the ERAS protocol can be conducted safely. The success of such protocols relies on careful patient selection, a multidisciplinary approach, and care tailored to each patient and their treatment plan.