NutriCatt protocol in the enhanced recovery after surgery (ERAS) program for colorectal surgery: the nutritional support improves clinical and cost-effectiveness outcomes.

Introduction Post-operative complications (POC) and length of hospital stay (LOS) are major issues and impact on hospital costs. Enhanced recovery after surgery (ERAS) protocols are effective in reducing morbidity and LOS after major surgery. We propose a nutritional protocol within ERAS program in colorectal surgery, starting from preadmission. Methods We compared ERAS + NutriCatt approach versus ERAS standard program adopted in our centre in the previous months. Complications, LOS, hospital readmission at 30 days and late complications (at 90 days) were assessed and compared. A cost-effectiveness analysis was performed. Results 114 patients were treated according to ERAS program between April 2015 and January 2016; 105 were enrolled in ERAS + Nutricatt protocol from February to September 2016; Patients' characteristics were similar in the two groups, except for American Society of Anesthesiologists (ASA) score, significantly worse in the ERAS+Nutricatt cohort; preoperative diagnoses and surgical approaches were similar in the two periods. LOS was significantly inferior in ERAS + NutriCatt protocol (4.9 ± 1.7 days; 95% CI 4.60- 5.28) than in standard ERAS program (6.1 ± 3.9 days, 95% CI 5.36 – 6.81) (p=0.006), as well as POC (36, 34.3% vs 55, 48.2%; p= 0.03). Complications within 90 days were 0 in ERAS + NutriCatt and 4 in ERAS standard cohort. Cost-effectiveness analyses showed savings in the ERAS+ NutriCatt protocol. Conclusions Nutritional care, starting from the preadmission visit, is able to reduce LOS, postoperative and late complications and costs, in addition to ERAS standard items in colorectal surgery.