Our study results showed that minimally invasive surgeries are associated with decreased length of the stay in the hospital after the surgery. Median day of discharge of day in open surgery was 5  and with the minimally invasive surgeries (MIS) was 4 And there was no difference in postop morbidity. We found statistically significant correlation between patients who underwent bowel preparation vs no bowel preaperation with decrease in Clavien Dindo grading in patients in whom bowel preparation was not done. Majority of patients in current audit had prolonged fasting (>6hours) In our study 46.5% patients received only single antiemetic agent. Our nurse patient ratio is quite poor in recovery room and surgeons are uncomfortable to send patients to recovery area without NGT but happy to remove it by 10-12 hours after surgery and thus almost 95.7 % patients had their NGT removed within 24 hours post-surgery. 5% patients who had NGT retained after 24 hours had significantly higher hospital length of stay (LOS) (median 5 days vs 7.5 days). Probably these patients had some problem like prolonged ileus or complicated bowel resections which increased hospital LOS rather than delayed removal of NGT. In our audit 29.6 % patients did not get drains and 8.9 % of patients drain was removed within 24 hours. Patients who had surgical drains for >24 hours had increased hospital LOS.  

32% of our patients had urinary catheter in place for more than 24 hours. And we found that early removal of urinary catheter had a statistically significant association with decreased post-operative morbidity outcomes as well as reduced readmissions and less hospital LOS. Our study showed that our surgeons were quite comfortable starting liquids orally within 24 hours but reluctant to give solids. We found that early oral fluid diet significantly decreased postoperative length of stay from 5 [2] to 3.5[1] and decreased the post-operative complications as per Clavien Dindo grading.Our study showed that our surgeons were quite comfortable starting liquids orally within 24 hours but reluctant to give solids. We found that early oral fluid diet significantly decreased postoperative length of stay from 5 [2] to 3.5[1] and decreased the post-operative complications as per Clavien Dindo grading.

What our study results show is our compliance to ERAS bundles is exteremely poor. Most of the elements where we found good compliance are part of standard practice for many years and not necessarily as part of ERAS bundles. Elements like preoperative antibiotic, avoidance of night sedation, multimodal analgesia are decided by anaesthetist and have excellent compliance. However other elements especially where surgeons are major decision makers, compliance rate is still very poor and probably reflect lack of awareness and unwillingness to adopt change. With proper education and institution of protocols, it is possible to improve compliance and postoperative outcomes