Colorectal surgery in older patients under ERAS: Outcomes, benefits and implementation barriers

Abstract

centre, but also its impact on clinical outcomes, when applied to cystectomy patients. Methods: From October 2012 to December 2015, unselected consecutive patients undergoing open radical cystectomy were prospectively included in an ERAS ® care pathway as previously published. Demographic and surgical details were documented prospectively by a dedicated clinical nurse. Definition of compliance was established for each ERAS ® care item. Overall protocol compliance and individual compliance for each item was assessed. A cutoff of 80% of compliance was set a priori, in order to dichotomise between compliant and noncompliant patients. Outcome measures were functional recovery, severe complications (3 grade Clavien classification), hospital length of stay and readmission rate. Results: Seventy-two patients underwent a radical cystectomy within an ERAS ® pathway. Mean compliance with ERAS ® protocol was 87%. Overall major complication and readmission rates were 35% (25/72) and 14% (10/ 72) respectively. Bowel recovery was achieved in a mean of 6.7 days and median length of stay was 16 days. When dichotomised between compliant (n¼46, compliance to the ERAS protocol >80%) and non-compliant patients (n¼26), no significant differences were found in morbidity, readmission rate and length of stay. Univariate analysis identified early mobilisation and early oral nutrition as significant risk factors for morbidity. Conclusion: Our ERAS ® pathway implementation failed to show an improvement in functional recovery, length of stay and 30 days morbidity after cystectomy. While early oral nutrition and early mobilisation represent key ERAS ® items in colorectal surgery, they might not be appropriate for cystectomy patients.