Correlation between inflammatory markers and enhanced recovery after surgery (ERAS) failure in laparoscopic colectomy.

Purpose: To evaluate inflammatory markers to identify patients at risk of enhanced recovery after surgery (ERAS) failure following laparoscopic colectomy.

Methods: We included patients who underwent laparoscopic colectomy between September 2020 and February 2023. ERAS failure was defined as intolerance of a soft diet on postoperative day (POD) 2, postoperative stay > 7 days, or readmission within 30 days postoperatively. Inflammatory markers were analyzed immediately postoperatively and on POD 1 and 3. All patients were subjected to the ERAS protocol and divided into success and failure groups.

Results: Data from 402 patients (success, 330; failure, 72) were analyzed. The neutrophil-to-lymphocyte ratio (p < 0.001), platelet-to-lymphocyte ratio (p = 0.004), monocyte-to-lymphocyte ratio (p = 0.041), and C-reactive protein-to-albumin ratio (CAR; p < 0.001) were elevated in the failure group on POD 3. The immediate postoperative CAR was higher in the failure group (p = 0.045). ERAS failure occurred more frequently in patients with body mass index < 20 (p < 0.001), right colon tumors (p = 0.012), and longer operative time (p < 0.001).

Conclusions: This study demonstrated that inflammatory markers are associated with ERAS failure. Among the inflammatory markers, CAR might be the most potent indicator of ERAS failure following laparoscopic colectomy.