Implementation of Enhanced Recovery After Surgery Guidelines in Colorectal Operations in Tehran Hospitals, Iran Publisher



Hajabi R ; Amoli H A ; Khalooeifard R ; Rahmani J ; Behboodi B ; Alemrajabi M
Source: International Journal of Nutrition Sciences Published:2026

Abstract

Background: Enhanced Recovery after Surgery (ERAS) protocols are designed to improve perioperative care and postoperative recovery; however, implementation varies across hospitals. Data on ERAS use in colorectal surgery in Tehran hospitals are limited. This study evaluated ERAS implementation in colorectal surgery, focusing on nutrition, surgery, and anesthesia-related components. Methods: This observational cross-sectional study was conducted in Tehran hospitals from June 2024 to February 2025. Patients undergoing colorectal surgery were included. Using a questionnaire based on the latest ERAS protocols, designated hospital staff assessed protocol implementation from admission to discharge. Completed questionnaires were included in the final analysis. Results: Low anterior resection (LAR) was the most frequent procedure (25.5%), while abdominoperineal resection (APR) was the least common method. Significant differences were observed between public and private hospitals in 9 of 24 items including patient introduction to ERAS protocols (74.2%), admission timing (74.3%), preadmission counseling (100% private), regional anesthesia use (0% private), preferred analgesia route (74.8%), initiation of oral fluids (100% private), oral diet (100% private), early mobilization (100% private), and urinary catheter removal timing (73.6%). The remaining 15 items showed no significant differences. Eight ERAS elements, including fasting duration modification, carbohydrate loading, preoperative pain control, intrathecal analgesia, gum chewing, intraoperative temperature monitoring, chronic pain prevention, and ileus prevention, were absent in all hospitals. Conclusion: This study provided a comprehensive evaluation of ERAS protocol implementation in colorectal surgeries in Tehran, revealing substantial gaps. Disparities between public and private sectors highlight the need for targeted interventions to improve adherence. © International Journal of Nutrition Sciences.