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Introduction: Enhanced Recovery Programs (EPR) have been shown to reduce mortality, morbidity and length of stay. Can similar results be produced in tertiary centres with the presence of complex colorectal cases? Method: 102 patients were prospectively analysed with a power calculation of 34 being established prior to commencement of the study. The average age was 66.6 (male: female ratio of 1:1). Data collection included demographics, operative procedure, pain scores, POSSUM scores, American Society of Anaesthiology (ASA) scores, and discharge times. All complications were documented. Results: 83 cases were open procedures and 19 laparoscopically, (3 were converted intra-operatively). The majority were anterior resection (47, [46.1%]) and right hemicolectomies (32, [31.3%]). The average overall discharge time was 11.75 days compared to 15.11 (p < 0.001) prior to commencement of the study in 2005. Anterior resections and subtotal colectomies (14.3 and 13.7 days respectively) had significantly longer lengths of stay compared to right hemicolectomies (10.7 days) [p < 0.001]. 56% patients were ASA grade 3 & 4 (50% and 6% respectively). A clear correlation with increasing ASA and discharge time was demonstrated (ANOVA p = 0.0004) with significant exponential rise with ASA greater than 2. POSSUM scoring demonstrated a positive correlation with prolonged hospital stay with increasing scores having worse discharge time. Conclusion: In the presence of complex major surgery and tertiary centre referrals an ERP is feasible producing an average saving of 3.36 days. The benefit is however less with increasing ASA and POSSUM Scores. It however still produced an average economic bed stay saving cost of $3700 per patient stay. [ABSTRACT FROM AUTHOR]