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<p>ERAS programmes are widely used in colorectal surgery, but the impact of overall pathway compliance on outcomes in elderly colorectal cancer patients and the mechanisms linking compliance to recovery are unclear. We retrospectively analysed 206 elderly patients (median age 72&#xa0;years) who underwent elective colorectal cancer resection within an ERAS pathway (2020–2023). Overall ERAS compliance was classified as high (≥ 70%, n = 114) or low (&lt; 70%, n = 92). Outcomes included major complications (Clavien–Dindo III–V), length of stay (LOS), Comprehensive Complication Index (CCI), time to first flatus/defecation, readmission, mortality, and hospital costs. Subgroup analyses and structural equation modelling (SEM) assessed direct and indirect pathways between compliance and outcomes. High compliance was associated with fewer major complications (16.7% vs 29.3%, <i>P</i> = 0.048), lower CCI (18.6 ± 9.5 vs 22.1 ± 10.4, <i>P</i> = 0.014), and shorter LOS (8.2 ± 2.6 vs 10.1 ± 3.1&#xa0;days, <i>P</i> = 0.003). Gastrointestinal recovery was faster (flatus 2.3 ± 0.8 vs 2.9 ± 1.0&#xa0;days; defecation 3.8 ± 1.1 vs 4.5 ± 1.2&#xa0;days; both <i>P</i> &lt; 0.001), and costs were lower (64.8 ± 15.2 vs 72.5 ± 18.1 × 10<sup>3</sup> RMB, <i>P</i> = 0.003). Readmission and 30-day mortality were low and similar between groups. SEM indicated that higher compliance directly reduced complications, CCI, and LOS, and indirectly reduced 30-day readmission via complications and LOS. In elderly colorectal cancer surgery, higher ERAS compliance is associated with lower morbidity, faster recovery, shorter LOS, and lower costs without increased short-term readmission or mortality, supporting efforts to monitor and improve adherence.</p>

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Compliance with an enhanced recovery pathway and postoperative outcomes in elderly colorectal cancer patients: a real-world cohort and structural pathway analysis

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Liping Feng,
  • Qingyong Huang,
  • Songchun Liu,
  • Shuang Wu

摘要

ERAS programmes are widely used in colorectal surgery, but the impact of overall pathway compliance on outcomes in elderly colorectal cancer patients and the mechanisms linking compliance to recovery are unclear. We retrospectively analysed 206 elderly patients (median age 72 years) who underwent elective colorectal cancer resection within an ERAS pathway (2020–2023). Overall ERAS compliance was classified as high (≥ 70%, n = 114) or low (< 70%, n = 92). Outcomes included major complications (Clavien–Dindo III–V), length of stay (LOS), Comprehensive Complication Index (CCI), time to first flatus/defecation, readmission, mortality, and hospital costs. Subgroup analyses and structural equation modelling (SEM) assessed direct and indirect pathways between compliance and outcomes. High compliance was associated with fewer major complications (16.7% vs 29.3%, P = 0.048), lower CCI (18.6 ± 9.5 vs 22.1 ± 10.4, P = 0.014), and shorter LOS (8.2 ± 2.6 vs 10.1 ± 3.1 days, P = 0.003). Gastrointestinal recovery was faster (flatus 2.3 ± 0.8 vs 2.9 ± 1.0 days; defecation 3.8 ± 1.1 vs 4.5 ± 1.2 days; both P < 0.001), and costs were lower (64.8 ± 15.2 vs 72.5 ± 18.1 × 103 RMB, P = 0.003). Readmission and 30-day mortality were low and similar between groups. SEM indicated that higher compliance directly reduced complications, CCI, and LOS, and indirectly reduced 30-day readmission via complications and LOS. In elderly colorectal cancer surgery, higher ERAS compliance is associated with lower morbidity, faster recovery, shorter LOS, and lower costs without increased short-term readmission or mortality, supporting efforts to monitor and improve adherence.