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Inicio Cirugía Española (English Edition) ERAS protocol compliance impact on functional recovery in colorectal surgery
Journal Information
Vol. 99. Issue 2.
Pages 108-114 (February 2021)
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Vol. 99. Issue 2.
Pages 108-114 (February 2021)
Original article
DOI: 10.1016/j.cireng.2021.01.014
ERAS protocol compliance impact on functional recovery in colorectal surgery
Impacto del grado de cumplimiento de un protocolo ERAS en la recuperación funcional después de cirugía colorrectal
Macarena Barberoa,
Corresponding author

Corresponding author.
, Javier Garcíaa,b, Isabel Alonsoc, Laura Alonsoa, Belén San Antonio-San Romána, Viktoria Molnara, Carmen Leónc, Matías Ceac
a Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
b Instituto de Investigación Sanitaria, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
c Servicio de Cirugía General, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Figures (2)
Tables (5)
Table 1. ERAS HUPHM protocol.
Table 2. Demographic variables, surgical variables, and compliance of the ERAS HUPHM protocol strategies, according to the ERAS Society guidelines7,8.
Table 3. Biochemical results, complications and postoperative evolution.
Table 4. Univariate analysis of results.
Table 5. Multivariate analysis of independent factors associated with meeting discharge criteria on the fifth day or before.
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Compliance to ERAS protocols is a process quality measure that is associated with better outcomes. The main objective of this study is to analyze the association between protocol compliance, surgical stress and functional recovery. The secondary objective is to identify independent factors associated with functional recovery.


A prospective observational single-center study was performed. Patients who had scheduled colorectal surgery within an ERAS program from January 2017 to June 2018 were included. We analyzed the relationship between protocol compliance percentage and surgical stress (defined by C-reactive protein [CRP] blood levels on postoperative 3rd day), and functional recovery (defined by the proportion of patients who met the discharge criteria on the 5th PO day or before). Multivariate analysis was performed to assess independent factors associated with functional recovery.


313 patients were included. For every additional percentage point of compliance to the protocol 3rd day, C-reactive protein plasma level decreased 1.46 mg/dL and the probability to meet the discharge criteria increased 7% (P < .001 both). Independent factors associated with functional recovery were ASA III-IV (OR 0.26; 0.14−0.48), surgical CR-POSSUM score (OR 0.68; 0.57−0.83), early mobilization (OR 4.22; 1.43−12.4) and removal of urinary catheter (OR 3.35; 1.79−6.27), P < .001 each.


Better compliance with ERAS protocol in colorectal surgery decreases surgical stress and accelerates functional recovery.

Enhanced recovery
Functional recovery
Surgical stress
Protocol compliance
Colorectal surgery

El grado de cumplimiento de los protocolos de Enhanced Recovery After Surgery (ERAS) es una medida de calidad del proceso, que además se asocia a mejores resultados. El objetivo del presente estudio es analizar la relación existente entre el grado de cumplimiento del protocolo, el estrés quirúrgico y la recuperación funcional. Se plantea como objetivo secundario, la identificación de factores independientes asociados a la recuperación funcional.


Estudio retrospectivo observacional unicéntrico de pacientes sometidos a cirugía colorrectal programada dentro de un programa ERAS entre enero de 2017 y junio de 2018. Se analizó el grado de cumplimiento del protocolo porcentual y su relación con el estrés quirúrgico (definido por los niveles plasmáticos de proteína C reactiva al tercer día), y la recuperación funcional (definida por el cumplimiento de los criterios de alta el quinto día postoperatorio o antes). Se llevó a cabo un análisis multivariante de factores independientes asociados a recuperación funcional.


Se analizaron 313 pacientes. Por cada punto porcentual de cumplimiento adicional del protocolo disminuye 1,46 mg/dL la proteína C reactiva del tercer día y aumenta un 7% la probabilidad de cumplir criterios de alta (p < 00,1 ambos). Los factores asociados a recuperación funcional fueron ASA III-IV (OR 0,26; 0,14-0,48), puntuación CR-POSSUM quirúrgico (OR 0,68; 0,57-0,83), movilización precoz (OR 4,22; 1,43-12,4) y retirada precoz de sonda vesical (OR 3,35; 1,79-6,27), todos ellos p < 0,001.


El aumento del grado de cumplimiento del protocolo ERAS en cirugía colorrectal, disminuye el estrés quirúrgico y acelera la recuperación funcional.

Palabras clave:
Rehabilitación multimodal
Recuperación funcional
Estrés quirúrgico
Cumplimiento del protocolo
Cirugía colorrectal


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