Enhanced recovery after colorectal surgery in patients with inflammatory bowel disease to reduce hospital length of stay: A systematic review and meta‐analysis

Abstract Aim Enhanced recovery after surgery (ERAS) improves outcomes in colorectal cancer surgery; however, patients with inflammatory bowel disease (IBD) have been relatively excluded from these analyses. The purpose of this systematic review was to evaluate the effects of ERAS protocols in adult patients with IBD. Methods Relevant databases were searched for randomised‐controlled trials (RCTs) and controlled observational studies that assessed ERAS protocols versus conventional care in adult patients with IBD, in any language until July 21, 2025. Two authors independently identified trials, extracted data, assessed risk of bias (ROB 2.0 and ROBINS‐I) and evidence certainty (GRADE). Primary outcomes were length of stay (LOS), 30‐day readmissions, re‐operations and complications. Results Eighteen studies (one RCT, 17 observational) were included. LOS was significantly lower in the ERAS group (mean difference: −1.62 days; 95% CI: −2.03, −1.21, 15 studies, 4225 patients, moderate certainty). There was no difference in 30‐day readmissions (odds ratio, OR: 0.83; 95% CI: 0.62, 1.12, 15 studies, 4157 patients, low certainty), 30‐day reoperations (OR: 0.68; 95% CI: 0.46, 1.02, 8 studies, 2161 patients, very low certainty), or 30‐day complications (OR 0.69; 95% CI: 0.45, 1.08, 14 studies, 4074 patients, low certainty). Evidence certainty was limited by non‐blinding, and observational data at serious risk of bias. Conclusions ERAS for patients with IBD reduces LOS with no difference in 30‐day readmissions, reoperations and complications. Subgroup analyses generated the hypothesis that procedure‐specific ERAS pathways incorporating greater preoperative optimisation may provide additional benefit, but this requires confirmation in adequately powered randomised trials.