Outcomes of enhanced recovery after surgery in laparoscopic colorectal surgery: a systematic outcome mapping study and descriptive analysis to inform a core outcome set.

BACKGROUND

Enhanced recovery after surgery (ERAS) protocols have transformed perioperative care in laparoscopic colorectal surgery, aiming to optimize patient outcomes. However, heterogeneity in reported outcomes across randomized controlled trials (RCTs) limits evidence synthesis and clinical application. A core outcome set (COS) is urgently needed to standardize outcome reporting and enhance research comparability. This study aims to systematically map outcomes reported in ERAS RCTs for laparoscopic colorectal surgery, providing a foundation for developing a tailored COS specific to this subfield.

METHODS

Following PRISMA guidelines, we searched PubMed, Embase, and the Cochrane Library for RCTs published from inception to April 2025, assessing ERAS protocols in laparoscopic colorectal surgery. Studies were included if they were RCTs comparing ERAS interventions with standard care or other ERAS variants. Data on study characteristics, interventions, and reported outcomes were extracted and categorized into domains using narrative synthesis. Outcome frequency and measurement variability were analyzed. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

RESULTS

From 57 included RCTs (n = 7502 patients), 86 unique outcomes were identified across 9 domains: gastrointestinal recovery (25.6%, e.g., time to first flatus, 45.6% of studies), postoperative pain (18.6%, e.g., Visual Analogue Scale pain scores, 31.6%), hospital stay (14.0%, e.g., length of stay, 38.6%), postoperative complications (15.1%), physical function (9.3%), immune and inflammatory response (7.0%), patient-reported outcomes (4.7%), postoperative nausea and vomiting (3.5%), and economic outcomes (2.3%). Outcome definitions and measurement tools varied widely, with no consistent standardization.

CONCLUSIONS

This study highlights heterogeneity in ERAS outcome reporting, emphasizing the need for a COS. The identified domains and outcomes provide a foundation for standardizing research, improving evidence quality, and guiding clinical practice.