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The following is a summary of “Association of Enhanced Recovery After Surgery (ERAS) with textbook outcomes among patients undergoing surgery for rectal cancer,” published in the April 2025 issue of Surgery by Moazzam et al. 

Surgical resection remains the primary curative approach for nonmetastatic rectal cancer; however, it is frequently associated with a range of adverse short-term postoperative outcomes that can compromise recovery and long-term prognosis. This study aimed to identify key clinical and procedural factors influencing the likelihood of achieving optimal surgical results, defined as a composite “Textbook Outcome.” A retrospective multicenter cohort analysis was conducted using data from the U.S. Rectal Cancer Consortium, encompassing patients who underwent rectal cancer surgery between 2007 and 2018. The primary endpoint, Textbook Outcome, was defined as the absence of any postoperative complications, no extended length of hospital stay (greater than the 75th percentile), no readmission within 90 days, and no mortality within 90 days post-surgery. 

Of the 1,102 patients included, only 41.8% (n=461) met all criteria for a Textbook Outcome, highlighting the room for improvement in perioperative care. Multivariable logistic regression analysis was performed to identify independent predictors of this composite outcome. Several patient- and procedure-related factors were associated with reduced odds of achieving optimal results. Specifically, patients with an American Society of Anesthesiologists–Physical Status (ASA-PS) score greater than 2 had significantly lower odds ([OR] 0.66; 95% [CI], 0.50–0.88), as did those with a history of diabetes (OR 0.57; 95% CI, 0.38–0.87). Longer operative durations exceeding 3.5 hours (OR 0.52; 95% CI, 0.39–0.69) and perioperative transfusion of packed red blood cells (OR 0.20; 95% CI, 0.12–0.34) were also strongly associated with suboptimal outcomes. 

In contrast, implementation of ERAS protocols was a significant positive predictor, with patients undergoing ERAS nearly twice as likely to achieve a Textbook Outcome (OR 1.93; 95% CI, 1.45–2.58). These findings emphasize that while surgical technique remains important, systemic patient optimization and perioperative strategies play a critical role in shaping short-term outcomes. Notably, the strong association between ERAS and improved results suggests that standardized perioperative care pathways can mitigate risk, enhance recovery, and reduce variability in outcomes. This study underscores the need for targeted interventions in preoperative risk stratification, intraoperative efficiency, and postoperative management to promote the attainment of ideal surgical outcomes. 

As the healthcare system increasingly shifts toward value-based care, achieving consistent, complication-free recoveries should be a benchmark for surgical quality. Future efforts should focus on expanding access to enhanced recovery protocols, minimizing avoidable surgical stressors, and optimizing patients with high risk prior to rectal cancer surgery to improve the overall quality and consistency of care delivery.

Source: surgjournal.com/article/S0039-6060(24)01049-3/abstract