Enhanced recovery after surgery compliance and postoperative recovery in elderly colorectal cancer patients: a propensity score matched cohort study

Background: Enhanced Recovery After Surgery (ERAS) pathways are standard in colorectal surgery, but evidence in elderly patients is limited. This study evaluated the impact of ERAS adherence on outcomes after curative colorectal cancer (CRC) resection in patients ≥65 years. Methods: A single-centre, retrospective cohort of elderly CRC patients undergoing elective resection (2021-2024) was analysed. Adherence to 15 ERAS items was assessed; ≥80% (≥12 items) defined high compliance. Propensity score matching (1:1) balanced baseline characteristics. Primary endpoints were postoperative length of stay (LOS) and 30-day major morbidity; secondary endpoints included recovery milestones and 12-month functional outcomes. Results: Of 256 screened patients, 150 were matched (75 per group). High compliance was associated with shorter LOS, higher discharge within 10 days (73.3% vs 40.0%; p<0.01), and fewer major complications (14.0% vs 22.0%; p=0.043). Recovery milestones occurred earlier in the high-compliance group: ambulation (22.6 vs 26.1 h), bowel recovery (32.1 vs 36.0 h), and oral intake (30.5 vs 34.8 h). At 12 months, more patients resumed a normal diet without obstructive symptoms (92.9% vs 81.5%; p=0.021). Conclusions: In elderly CRC patients, high ERAS compliance was linked to shorter LOS, reduced morbidity, faster recovery, and sustained dietary benefit. Improving adherence may optimise outcomes, warranting validation in multicentre studies.