Institute of Oncology Ljubljana
Like many clinical teams, the Department for Abdominal Surgical Oncology at the Institute of Oncology Ljubljana in Slovenia had been working on their own to implement ERAS® for many years. Without a structured framework and systematic auditing tools, it was difficult to gauge how well the ERAS® concept worked.
The Department for Abdominal Surgical Oncology at the Institute of Oncology Ljubljana has become the first ERAS® Qualified Center in Slovenia, achieving ERAS® Qualification for colorectal surgery based on criteria defined from the ERAS® Society. In just eight months, the team cut the average length of stay nearly in half, brought complications down from 78% to 18%, and reduced readmissions to zero — while raising compliance towards ERAS® best practice from 47% to 79%.
| Measure | Before ERAS® | After ERAS | Change |
|---|---|---|---|
| Length of stay | 11.7 days | 6.3 days | -46% |
| Complications | 78.4% | 18.2% | -77% |
| ICU admissions | 41.2% | 9.1% | -78% |
| Readmissions | 4% | 0% | -100% |
| ERAS® protocol compliance | 46.8% | 79% | +32% |
“Becoming the first ERAS® Qualified Center in Slovenia through the successful implementation of the ERAS® colorectal surgery pathway within our Department for Abdominal Surgical Oncology, is an important milestone for our team and our hospital. However, the true value of this achievement lies in better care, recovery, and overall outcomes for our patients.
The ERAS® implementation journey taught us that meaningful change is only possible when people work together with trust, respect, and a shared purpose. Although the process brought challenges and different perspectives, it also reminded us that our greatest strength lies in collaboration and in focusing on our shared goals rather than our differences.
We are proud of what we have achieved together, and we remain committed to continuous improvement, multidisciplinary teamwork, and providing the highest quality care for every patient.”
— The team at the Department for Abdominal Surgical Oncology, Institute of Oncology Ljubljana, Slovenia
The Institute of Oncology Ljubljana is Slovenia’s national cancer center, located in Ljubljana. Its Department for Abdominal Surgical Oncology specializes in the surgical treatment of abdominal cancers, including colorectal cancer, caring for approximately 200 patients per year from across the country. The department operates as a referral center for colorectal oncology at a national level, bringing together a core multidisciplinary team of surgeons, anesthesiologists, nurses, dietitians, physiotherapists, and clinical coordinators.
The team at the Institute of Oncology Ljubljana had been working with ERAS® since 2006. They had developed parts of the pathway and achieved improvements in some areas — but, like many clinical teams, they fell short of being able to measure compliance towards the best practice guidelines in order to obtain a sustainable way of working. They brought years of clinical commitment with them. What was missing was structure.
The team began using the ERAS® Interactive Audit System (EIAS) to audit their practice systematically, identifying exactly where the gaps were and what needed to change. What followed was a concentrated period of process improvements: the team developed educational materials for both staff and patients, held internal presentations to build awareness across the department, and worked through challenges together using a plan-do-study-act approach.
One of those challenges was navigating a transition to the updated colorectal protocol mid-implementation. Thanks to their structured approach to change management, the team absorbed the update without significant disruption to the implementation timeline.
Throughout the implementation, the team was guided and coached by Professor Emeritus Olle Ljungqvist of Örebro University Hospital in Sweden and ERAS® Society Founder and Ambassador. The implementation program ran over a period of only eight months.
This was a genuinely multidisciplinary effort, bringing together surgeons, anesthesiologists, a clinical dietitian, a physiotherapist, a surgical nurse, an anesthesiology nurse, a clinical nutrition specialist, and management representation. Clinical leads Dr. Erik Brecelj and Dr. Rok Petreč, alongside ERAS® coordinator Ms. Brigita Avramović Brumen, led a team that ultimately described one of the most valuable outcomes of the process as something less visible than a compliance score: a functional, sustainable framework for teamwork.
The Institute of Oncology Ljubljana serves colorectal cancer patients from across Slovenia, treating approximately 200 patients per year in this department alone. The team is already planning to extend the reach of their work beyond the institution, with a national ERAS® symposium planned for 1 October 2026 to bring together stakeholders from across the country.
ERAS® Qualification is not the endpoint. For this team, it marks the beginning of sustained work and audit, continuous staff education, and broader ERAS® adoption across Slovenia.