Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care
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The aim of the study was to evaluate the benefits of implementing Enhanced Recovery After Surgery (ERAS) protocols in elderly patients undergoing elective colorectal surgery.
A retrospective non-randomized cohort study was conducted from September 2012 to December 2016. We included patients ≥ 70 years undergoing elective colorectal surgery. Outcome measures, compliance with interventions, and postoperative complications of patients treated under ERAS were case-matched (based on gender, age, type of surgery, and the presence/absence of a temporal stoma) to a retrospective group of patients ≥ 70 years treated under conventional care.
A total of 312 patients (156 ERAS vs. 156 non-ERAS) were included in the study. The ERAS group had a significant reduction of grade III/IV Dindo-Clavien’s postoperative complications when compared with conventional care. ERAS had a positive effect in reducing anastomotic leakage (14.7% non-ERAS vs. 9%) and postoperative mortality (11.5% non-ERAS vs. 1.9% ERAS; p = 0.001). A reduction of 2 days in length of hospital stay was achieved after implementing ERAS (8 (6.75) vs. 6 (5.25); p < 0.0001), while readmission rates remained unaffected. The average of global compliance (GC) with all ERAS interventions was 42%. GC was significantly lower in patients with permanent/temporary stomas and in patients in whom an open approach was performed.
In our experience, ERAS should be implemented without reservations in elderly patients expecting the same goals and benefits as with other age groups. Barriers in achieving a high compliance rate are common and will require a great effort in patient’s education, an intensive perioperative care, and sometimes a change in the surgeons’ practice.
KeywordsERAS Elderly Colorectal cancer surgery Multimodal Enhanced recovery after surgery
The authors would like to thank Dr. Sara Rosenstone Calvo for editing this manuscript.
Patricia Tejedor and Carlos Pastor contributed equally in analyzing the data and writing the manuscript. The rest of the authors critically revised the paper for important intellectual content. All authors have contributed to the work and agreed on the final version. This manuscript is not being considered by any other journal.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA, Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group, Enhanced Recovery after Surgery (ERAS) Group (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809. https://doi.org/10.1002/bjs.5384 CrossRefPubMedGoogle Scholar
- 3.Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149:830–840. https://doi.org/10.1016/j.surg.2010.11.003 CrossRefPubMedGoogle Scholar
- 4.Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. (2011), Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev: CD007635. https://doi.org/10.1002/14651858.CD007635.pub2
- 8.Gonzalez-Ayora S, Pastor C, Guadalajara H, Ramirez JM, Royo P, Redondo E, Arroyo A, Moya P, Garcia-Olmo D (2016) Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. Int J Color Dis 31:1625–1631. https://doi.org/10.1007/s00384-016-2621-7 CrossRefGoogle Scholar
- 10.Hendry PO, Hausel J, Nygren J, Lassen K, Dejong CH, Ljungqvist O, Fearon KC, Enhanced Recovery After Surgery Study Group (2009) Determinants of outcome after colorectal resection within an enhanced recovery programme. Br J Surg 96:197–205. https://doi.org/10.1002/bjs.6445 CrossRefPubMedGoogle Scholar
- 13.Walter CJ, Watson JT, Pullan RD, Kenefick NJ, Mitchell SJ, Defriend DJ (2011) Enhanced recovery in major colorectal surgery: safety and efficacy in an unselected surgical population at a UK district general hospital. Surgeon 9:259–264. https://doi.org/10.1016/j.surge.2010.10.003 PubMedCrossRefGoogle Scholar
- 16.Feroci F, Lenzi E, Baraghini M, Garzi A, Vannucchi A, Cantafio S et al (2013) Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery. Surg Laparosc Endosc Percutan Tech 23:259–265. https://doi.org/10.1097/SLE.0b013e31828ba16f CrossRefPubMedGoogle Scholar
- 21.Forsmo HM, Erichsen C, Rasdal A, Korner H, Pfeffer F (2017) Enhanced recovery after colorectal surgery (ERAS) in elderly patients is feasible and achieves similar results as in younger patients. Gerontol Geriatr Med 3:2333721417706299. https://doi.org/10.1177/2333721417706299 PubMedPubMedCentralCrossRefGoogle Scholar