INTRODUCTION
Enhanced Recovery After Surgery(ERAS) care pathway reduce surgical stress, maintain postoperative physiological function and enhance mobilization after surgery, reducing morbidity and length of hospital stay(LOHS). 
The aim of this study was to evaluate the institutional compliance with a perioperative ERAS path and patients’ outcome in colorectal surgery(CS).

METHOD
A retrospective audit was conducted after Quality, Health and Safety Department approval. Data were collected from elective CS patient’s electronic medical records(2014_2016). Analyzed variables: age, gender, American Society of Anesthesiologists Physical Status (ASA), comorbidities, Colorectal Physiological and Operative Severity Score for the enumeration of Mortality and Morbility(CR POSSUM), compliance with perioperative ERAS items, LOHS, and perioperative complications using the Clavien-Dindo classification (CDc). Descriptive statistical analysis, Pearson and Spearman correlation and t-student test were run in SPSS® version24. 

RESULTS AND DISCUSSION
272 patients’ medical records were analyzed. Patients’ mean age was 64 years (18-89), 145 males. ASA 1(14), 2(171), 3(82) and 4(5).162 were laparoscopic procedures (59.56%) and 30(11.03%) converted to open surgery. General anesthesia was performed in 119 patients and combined anesthesia (transversus abdominal plane block/epidural) in 81 patients. Items that didn’t comply ERAS care: fasting>8h in all patients, bowel preparation (69.85%), use of benzodiazepines (45.46%) and abdominal drains(42.28%). 
Mean LOHS observed was 12.96 days and published data show a 5-day of LOHS with CS ERAS care. A positive relation was observed between the first feeding and ambulation day, the beginning of gastrointestinal transit and LOHS (p<0.001). Patient Control Analgesia with morphine was used in 45 patients with no significant increase in mean LOSH.
There were 28 re-interventions, 54 infectious complications and 40 other major medical complications. 1 death was observed at 108 days of LOSH (ASA 3 patient and CR POSSUM estimated a mortality of 14.8%). The CDc grade was positively related to CR POSSUM physiological score(r=0.246, p<0.001). There was a statistically significant difference between the means in physiologic and mortality CR POSSUM scores and a CDc>III (p<0.001).

CONCLUSION
The path to ERAS protocol implementation in our institution is a gradual but a critical process to improve patients’ outcome in CS.


08 / The Path to Enhance Recovery after Colorectal Surgery