Application of the Enhanced Recovery After Surgery (ERAS) programme in elective colorectal resection for diverticular disease: a retrospective propensity score-matched cohort study

Background: Diverticular disease is one of the most common benign colorectal conditions and often requires elective resection for recurrent or complicated presentations. Enhanced Recovery After Surgery (ERAS) programmes have demonstrated benefits in mixed colorectal populations; however, evidence in purely benign diverticular cohorts remains limited. This study evaluated the impact of a standardised ERAS pathway on postoperative outcomes following elective colorectal resection for diverticular disease. Methods: This retrospective multicentre cohort study included consecutive adults undergoing elective left-sided colorectal resection for diverticular disease between 2009 and 2024 in Northern Italy. Patients treated within an ERAS pathway were compared with those receiving conventional care. The primary outcome was length of hospital stay. Secondary outcomes included postoperative morbidity, gastrointestinal recovery, pain, mobilisation, and readmissions. Continuous variables were analysed with the Mann–Whitney U test and categorical variables with χ2 or Fisher’s exact test. A propensity score–matched analysis was performed to account for baseline and temporal confounding. Results: A total of 421 patients were included: 329 in the ERAS group and 92 in the non-ERAS group. Baseline characteristics were similar. ERAS adherence was associated with faster gastrointestinal recovery (median time to first flatus: 1 vs 2 days; stool: 1 vs 2 days), lower pain on POD 1 (VAS 2 vs 4), earlier mobilisation (12 h vs 21 h), and earlier solid diet introduction (POD 1 vs POD 2). Overall morbidity was lower in the ERAS group (6.6% vs 14%), without increases in severe complications or readmissions. Median LOS was reduced (4 vs 6 days). Propensity score matching (88 pairs) confirmed these findings. Conclusion: ERAS implementation in elective colorectal resection for diverticular disease is safe, feasible, and associated with accelerated recovery, reduced morbidity, and shorter hospital stay.