Background and aims The aim is to evaluate the effectiveness of an ERAS program based on hospital length of stay (LOS), readmission rates and postoperative complications, and to know if it was cost-effective.

Methods We compared 121 consecutive patients (ERAS group) operated on elective colorectal surgery according to an ERAS protocol, with a historical cohort of 135 (preERAS group) operated before the protocol. Inclusion criteria: elective colorectal surgery, ≥18 years, appropriate cognitive state and ASA I-II-III. Exclusion criteria: urgent surgery and higher concomitant surgical processes. The results are presented as number of patients and percentage (%) (preERAS vs ERAS) or mean ± standard deviation. Results were statistically significant when p<0.05.

Results Two groups were homogeneous, except there was more laparoscopic surgery in the ERAS group (27 [20%] vs 45 [37.2%], p = 0.006). The mean compliance of the protocol was 72.5% ± 11.40%. In the ERAS group, a decrease in LOS was observed (11 ± 3.8 vs 9.8 ± 3.7, p = 0.018), without increasing the complication rate (49 [36.3%] vs 38 [31.4%], p = 0.49), readmissions at 30 days after hospital discharge (15 [11.1%] vs 12 [9.9%], p = 0.756), mortality at 30 days after hospital discharge (1 [0.7%] vs 2 [1.7%], p = 0.498) and healthcare costs (average cost per patient) (1618.8€ ± 830.5 vs 1578.6€ ± 491.1, p = 0.634).

Conclusions ERAS protocol in elective colorectal surgery is cost-effective, because it improves the results (reduces LOS without increasing the rate of complications or readmissions) without increasing healthcare costs.