Optimized post-discharge care in patients with frailty after colon cancer surgery (project ERAS® 3.0): A protocol for a randomized controlled trial

INTRODUCTION: The incidence of colon cancer increases with age, and the primary treatment is surgical resection. Patients with frailty have a reduced ability to handle stressors and face a higher risk of complications and poor recovery after surgery. While Enhanced Recovery After Surgery (ERAS®) pathways improve in-hospital recovery, readmission rates remain high, and no structured post-discharge interventions exist for this population. Home-based post-discharge support may further enhance recovery in patients with frailty. This study evaluates the effect of an ERAS® 3.0 programme incorporating home-based geriatric, nutritional, and exercise interventions after discharge.

MATERIALS AND METHODS: This randomized controlled trial includes patients with colon cancer undergoing elective colonic resection within the ERAS® pathway during hospitalization. Patients with frailty (Clinical Frailty Scale score 4-7) and at nutritional risk (Nutritional Risk Screening 2002 ≥ 3) will be randomized 1:1 to either the intervention group (home-based geriatric, nutritional, and exercise interventions after discharge, n = 30) or standard post-discharge care (n = 30). The ERAS® 3.0 intervention includes protein-enriched foods and drinks at discharge, home-based comprehensive geriatric assessment, dietary counselling and exercise instructions, and outpatient follow-up with dietary counselling. The primary outcome is change in the Quality of Recovery-15 score from baseline to 12 ± 2 days after surgery. Secondary outcomes include quality of life, activities of daily living, energy and protein intake, appetite, 30-s chair-stand-test, muscle mass, total length of hospital stay, readmission rate, postoperative complications occurring after discharge, mortality, and costs.

DISCUSSION: This study extends the ERAS® principles beyond hospitalization, addressing the post-discharge needs of patients with frailty at nutritional risk following colon cancer surgery. While ERAS® protocols significantly improve in-hospital recovery, readmission rates remain high and structured post-discharge interventions are lacking. By incorporating home-based geriatric, nutritional, and exercise interventions, this study aims to reduce complications, improve functional recovery, and quality of life. A key strength is the use of patient-reported outcome measures, providing an assessment of recovery beyond traditional clinical metrics. If effective, the ERAS® 3.0 intervention could offer a strategy for optimizing post-discharge care for surgical patients with frailty.