International Journal of Colorectal Disease

, Volume 33, Issue 9, pp 1251–1258 | Cite as

Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care

  • Patricia TejedorEmail author
  • Carlos Pastor
  • Santiago Gonzalez-Ayora
  • Mario Ortega-Lopez
  • Hector Guadalajara
  • Damian Garcia-Olmo
Original Article



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.


ERAS Elderly Colorectal cancer surgery Multimodal Enhanced recovery after surgery 



The authors would like to thank Dr. Sara Rosenstone Calvo for editing this manuscript.

Author’s contribution

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.


  1. 1.
    Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298. CrossRefPubMedGoogle Scholar
  2. 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. CrossRefPubMedGoogle Scholar
  3. 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. CrossRefPubMedGoogle Scholar
  4. 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.
  5. 5.
    Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:1531–1541. CrossRefPubMedGoogle Scholar
  6. 6.
    Pawa N, Cathcart PL, Arulampalam TH, Tutton MG, Motson RW (2012) Enhanced recovery program following colorectal resection in the elderly patient. World J Surg 36:415–423. CrossRefPubMedGoogle Scholar
  7. 7.
    Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A (2014) A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Color Dis 16:947–956. CrossRefGoogle Scholar
  8. 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. CrossRefGoogle Scholar
  9. 9.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  10. 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. CrossRefPubMedGoogle Scholar
  11. 11.
    Rumstadt B, Guenther N, Wendling P, Engemann R, Germer CT, Schmid M, Kipfmueller K, Walz MK, Schwenk W (2009) Multimodal perioperative rehabilitation for colonic surgery in the elderly. World J Surg 33:1757–1763. CrossRefPubMedGoogle Scholar
  12. 12.
    Naef M, Kasemodel GK, Mouton WG, Wagner HE (2010) Outcome of colorectal cancer surgery in the early fast-track era with special regard to elderly patients. Int Surg 95:153–159PubMedGoogle Scholar
  13. 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. PubMedCrossRefGoogle Scholar
  14. 14.
    Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X (2012) Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Color Dis 14:1009–1013. CrossRefGoogle Scholar
  15. 15.
    Verheijen PM, Vd Ven AW, Davids PH, Vd Wall BJ, Pronk A (2012) Feasibility of enhanced recovery programme in various patient groups. Int J Color Dis 27:507–511. CrossRefGoogle Scholar
  16. 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. CrossRefPubMedGoogle Scholar
  17. 17.
    Keller DS, Lawrence JK, Nobel T, Delaney CP (2013) Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc 27:4463–4468. CrossRefPubMedGoogle Scholar
  18. 18.
    Baek SJ, Kim SH, Kim SY, Shin JW, Kwak JM, Kim J (2013) The safety of a "fast-track" program after laparoscopic colorectal surgery is comparable in older patients as in younger patients. Surg Endosc 27:1225–1232. CrossRefPubMedGoogle Scholar
  19. 19.
    Jia Y, Jin G, Guo S, Gu B, Jin Z, Gao X, Li Z (2014) Fast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. Langenbeck's Arch Surg 399:77–84. CrossRefGoogle Scholar
  20. 20.
    Kisialeuski M, Pedziwiatr M, Matlok M, Major P, Migaczewski M, Kolodziej D et al (2015) Enhanced recovery after colorectal surgery in elderly patients. Wideochir Inne Tech Maloinwazyjne 10:30–36. PubMedPubMedCentralCrossRefGoogle Scholar
  21. 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. PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Pirrera B, Lucchi A, Gabbianelli C, Alagna V, Martorelli G, Berti P, Panzini I, Fabbri E, Garulli G (2017) E.R.A.S. Pathway in colorectal surgery in elderly: our experience: a retrospective cohort study. Int J Surg 43:101–106. CrossRefPubMedGoogle Scholar
  23. 23.
    Kirchhoff P, Clavien PA, Hahnloser D (2010) Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg 4:5. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Widdison AL, Barnett SW, Betambeau N (2011) The impact of age on outcome after surgery for colorectal adenocarcinoma. Ann R Coll Surg Engl 93:445–450. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    van Vugt JL, Reisinger KW, Derikx JP, Boerma D, Stoot JH (2014) Improving the outcomes in oncological colorectal surgery. World J Gastroenterol 20:12445–12457. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Feng MA, McMillan DT, Crowell K, Muss H, Nielsen ME, Smith AB (2015) Geriatric assessment in surgical oncology: a systematic review. J Surg Res 193:265–272. CrossRefPubMedGoogle Scholar
  27. 27.
    Ommundsen N, Wyller TB, Nesbakken A, Jordhoy MS, Bakka A, Skovlund E et al (2014) Frailty is an independent predictor of survival in older patients with colorectal cancer. Oncologist 19:1268–1275. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General Surgery, Division of Colorectal SurgeryUniversity Hospital Fundacion Jimenez DiazMadridSpain

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