Accelerated enhanced recovery after colorectal surgery with early discharge: A systematic review and meta-analysis

PURPOSE: To evaluate whether accelerated enhanced recovery protocols increase rates of readmission, emergency department (ED) revisits, reoperation, or complications following colorectal surgery. METHODS: The protocol was prospectively registered in PROSPERO (CRD42024621268). A systematic search was perfomed in major databases including MEDLINE, EMBASE, and Cochrane databases. Primary outcomes was 30-day readmission rates. Secondary outcomes were ED revisits, reoperations, and complications. Risk of bias was assessed using the ROBINS-I tool. RESULTS: Thirteen studies involving 40,589 patients were included, with 1,783 patients in the aERPs group and 38,806 in the ERPs group. The meta-analysis revealed no statistically significant differences in 30-day readmission rates (OR 0.85, 95% CI 0.55–1.29, p = 0.43), ED revisits (OR 0.95, 95% CI 0.42–2.18, p = 0.91), reoperations (OR 0.97, 95% CI 0.61–1.54, p = 0.90), or complications (OR 0.47, 95% CI 0.17–1.32, p = 0.15). CONCLUSIONS: Accelerated ERPs with early discharge strategies, appear safe and feasible for selected patients undergoing minimally invasive colorectal surgery, with no increased risk of readmissions, ED visits, reoperations, or complications. Future high-quality randomized controlled trials are needed to refine patient selection criteria and optimize implementation of aERPs.