Influence of enhanced recovery after surgery protocol on first exhaust time after laparoscopic resection of colorectal cancer

Table 1 Comparison of patient baseline characteristics, n (%)/mean ± SD

Characteristic	Conventional group (n = 40)	ERAS group (n = 40)	Test statistic	P value
Age (years)	65.1 ± 11.8	64.3 ± 12.1	t = 0.387	0.700
Gender			χ2 = 0.089	0.766
Male	22 (55.0)	23 (57.5)
Female	18 (45.0)	17 (42.5)
BMI (kg/m2)	23.5 ± 2.9	23.4 ± 3.0	t = 0.156	0.876
Preoperative serum albumin (g/L)	39.2 ± 3.9	39.4 ± 3.8	t = 0.215	0.830
Tumor location			χ2 = 0.082	0.775
Colon	23 (57.5)	22 (55.0)
Rectum	17 (42.5)	18 (45.0)
TNM staging			χ2 = 0.456	0.800
Stage I	8 (20.0)	7 (17.5)
Stage II	19 (47.5)	20 (50.0)
Stage III	13 (32.5)	13 (32.5)
Tumor differentiation			χ2 = 0.289	0.865
Well differentiated	12 (30.0)	13 (32.5)
Moderately differentiated	21 (52.5)	20 (50.0)
Poorly differentiated	7 (17.5)	7 (17.5)
Operative time (minutes)	164.8 ± 31.9	163.5 ± 30.2	t = 0.218	0.828
Intraoperative blood loss (mL)	84.9 ± 27.8	83.1 ± 26.5	t = 0.325	0.746
Anesthesia time (minutes)	194.5 ± 34.8	192.8 ± 33.5	t = 0.237	0.813
ASA score			χ2 = 0.000	1.000
Grade I-II	32 (80.0)	32 (80.0)
Grade III	8 (20.0)	8 (20.0)

BMI: Body mass index; TNM: Tumor-node-metastasis; ASA: American Society of Anesthesiologists; ERAS: Enhanced recovery after surgery.

Table 2 Comparison of gastrointestinal function recovery indicators, n (%)/mean ± SD

Recovery parameter	Conventional group (n = 40)	ERAS group (n = 40)	Test statistic	P value
Time to first flatus (days)	3.5 ± 1.2	2.2 ± 0.8	t = 5.672	< 0.001
Time to first defecation (days)	4.8 ± 1.4	3.3 ± 1.0	t = 5.231	< 0.001
Time to bowel sounds recovery (days)	4.2 ± 1.3	2.5 ± 0.8	t = 6.894	< 0.001
Clear liquid tolerance on POD 1	25 (62.5)	37 (92.5)	χ2 = 12.345	< 0.001
Semi-liquid diet tolerance on POD 2	21 (52.5)	34 (85.0)	χ2 = 13.128	< 0.001
Normal diet on POD 5	30 (75.0)	38 (95.0)	χ2 = 8.571	< 0.01

POD: Post-operative day; ERAS: Enhanced recovery after surgery.

Table 3 Comparison of gastrointestinal discomfort symptoms and digestive function, n (%)/mean ± SD

Gastrointestinal symptom1	Conventional group (n = 40)	ERAS group (n = 40)	Test statistic	P value
Abdominal distension	22 (55.0)	11 (27.5)	χ2 = 7.892	< 0.01
Nausea	18 (45.0)	9 (22.5)	χ2 = 6.781	< 0.01
Vomiting	13 (32.5)	5 (12.5)	χ2 = 6.234	< 0.05
Hiccup episodes	9 (22.5)	3 (7.5)	χ2 = 4.587	< 0.05
Abdominal distension severity score	4.5 ± 2.0	2.7 ± 1.4	t = 4.678	< 0.001
Bloating-induced abdominal pain	5.1 ± 2.2	3.0 ± 1.7	t = 4.892	< 0.001
Good to fair appetite on day 3	19 (47.5)	31 (77.5)	χ2 = 11.234	< 0.001
Duration of anorexia (days)	4.0 ± 1.5	2.3 ± 1.0	t = 5.876	< 0.001
24-hour gastric residual volume (mL)	86.8 ± 34.9	47.9 ± 22.3	t = 4.012	< 0.001
Cumulative symptom burden score	15.1 ± 5.0	8.5 ± 3.1	t = 7.012	< 0.001

¹Symptom severity assessed using 0-10 visual analog scale, with higher scores indicating greater severity. Appetite categorized as poor, fair, or good based on percentage of food intake. Cumulative symptom burden represents the sum of all individual symptom severity scores.

ERAS: Enhanced recovery after surgery.

Table 4 Comparison of length of hospital stay and clinical outcomes, n (%)/mean ± SD

Clinical outcome indicator1	Conventional group (n = 40)	ERAS group (n = 40)	Test statistic	P value
Total hospital stay (days)	12.3 ± 3.2	9.1 ± 2.4	t = 5.123	< 0.001
Postoperative hospital stay (days)	9.5 ± 2.7	6.7 ± 2.0	t = 5.345	< 0.001
Preoperative hospital stay (days)	2.8 ± 0.8	2.4 ± 0.7	t = 2.345	0.021
Patients meeting discharge criteria on day 7	19 (47.5)	34 (85.0)	χ2 = 14.567	< 0.001
Prolonged hospitalization (> 14 days)	8 (20.0)	2 (5.0)	χ2 = 5.128	< 0.05
Time to resume normal activities (days)	18.2 ± 4.6	13.1 ± 3.7	t = 5.678	< 0.001
Direct medical costs (yuan)	51200 ± 9300	48100 ± 7500	t = 1.789	0.078
Medical costs for uncomplicated cases (yuan)	47600 ± 6800	43700 ± 5100	t = 2.891	< 0.01

¹Prolonged hospitalization defined as hospital stay exceeding 14 days. Normal activities include ability to independently perform daily self-care activities.

ERAS: Enhanced recovery after surgery.

Table 5 Postoperative complications, n (%)

Complication type	Conventional group (n = 40)	ERAS group (n = 40)	Test statistic	P value
Overall complications	13 (32.5)	5 (12.5)	χ2 = 5.342	< 0.05
Wound infection	6 (15.0)	2 (5.0)	χ2 = 3.987	0.046
Anastomotic leak	3 (7.5)	1 (2.5)		0.2581
Pulmonary infection	7 (17.5)	3 (7.5)	χ2 = 3.456	0.063
Urinary tract infection	3 (7.5)	1 (2.5)		0.2581
Intestinal obstruction	2 (5.0)	0 (0.0)		0.1541
Severe complications (grade III or above)	5 (12.5)	2 (5.0)		0.2211
30-day readmission	4 (10.0)	1 (2.5)		0.1781

¹Fisher’s exact test.

ERAS: Enhanced recovery after surgery.

Table 6 Changes in inflammatory markers, mean ± SD

Indicator	Time point	Conventional group (n = 40)	ERAS group (n = 40)	Test statistic	P value
WBC count (× 109/L)	Preoperative	6.6 ± 2.1	6.5 ± 2.0	t = 0.218	0.828
	POD 3	11.4 ± 3.2	9.1 ± 2.5	t = 3.678	< 0.001
	POD 7	8.8 ± 2.7	7.0 ± 2.2	t = 3.456	< 0.01
CRP (mg/L)	Preoperative	4.0 ± 1.9	3.8 ± 1.7	t = 0.512	0.610
	POD 3	22.8 ± 8.7	14.2 ± 6.4	t = 5.123	< 0.001
	POD 7	13.6 ± 5.9	7.8 ± 3.7	t = 5.456	< 0.001
Serum albumin (g/L)	Preoperative	39.2 ± 3.9	39.4 ± 3.8	t = 0.215	0.830
	POD 7	33.8 ± 4.1	36.3 ± 3.1	t = 3.012	< 0.01

ERAS: Enhanced recovery after surgery; WBC: White blood cell count; CRP: C-reactive protein; POD: Post-operative day.