E.R.A.S. pathway in colorectal surgery in elderly: Our experience: A retrospective cohort study

Pirrera, Basilio; Lucchi, Andrea; Gabbianelli, Carlo; Alagna, Vincenzo; Martorelli, Giacomo; Berti, Pierluigi; Panzini, Ilaria; Fabbri, Elisabetta; Garulli, Gianluca

doi:10.1016/j.ijsu.2017.05.013

Cited by 26 publications

(22 citation statements)

References 22 publications

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“…Three studies compared ERPs with conventional care in an older age group [16, 24, 28] (Table 1). Ten studies compared ERPs in old versus young patient groups [17, 18, 20, 22, 23, 25, 27, 29, 31, 35], while 2 studies compared ERPs in different older age groups [19, 32]. Three studies described ERPs in a single older age group [21, 34, 36].…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

et al. 2019

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Background Enhanced recovery programmes (ERPs) aim to attenuate the surgical stress response and accelerate recovery after surgery, but are not specifically designed for older patients. The objective of this study was to review the components, adherence and outcomes of ERPs in older patients (≥65 years) undergoing elective colorectal surgery. Methods Pubmed, Embase and Cinahl were searched between 2000 and 2017 for randomised and non-randomised controlled trials, before-after studies, and observational studies. The methodological quality of the studies was evaluated using the MINORS quality assessment. The review was performed and reported according to the PRISMA guidelines. Results Twenty-one studies, including 3495 ERP patients aged ≥65 years, were identified. The ERPs consisted of a median of 13 intervention components. Adherence rates were reported in 9 studies and were the highest (≥80%) for pre-admission counselling, no bowel preparation, limited pre-operative fasting, antithrombotic and antimicrobial prophylaxis, no nasogastric tube, active warming, and limited intra-operative fluids. The median post-operative length of stay was 6 days. The median post-operative morbidity rate (Clavien-Dindo I-IV) was 23.5% in-hospital and 29.8% at 30 days. The in-hospital post-operative mortality rate was 0% in most studies and amounted to a median of 1.4% at 30 days. The median 30-day readmission rate was 4.9% and the median reoperation rate was 5.0%. Conclusions ERPs in older patients were in accordance with the ERP consensus guidelines. Although the number of intervention components applied increased over time, outcomes in earlier and later studies remained comparable. Adherence rates were under-reported. Future studies should explore adherence and age-related factors, such as frailty profile, that could influence adherence. Trial registration PROSPERO 2018 CRD42018084756 . Electronic supplementary material The online version of this article (10.1186/s12877-019-1158-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…A total of 7610 patients were included in all studies, of whom 3495 (46%) patients (those ≥65 years in whom an ERP was applied) were considered in this review. Four studies divided the older patients in different age groups [17–19, 32]. As a consequence, the 21 studies included in this review comprised 26 study groups.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

et al. 2019

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“…Enhanced recovery after surgery pathways may help reduce postoperative morbidity and resource use in this high‐risk group. Recent studies demonstrate that these programs, which require active patient participation to achieve accelerated recovery goals, can be feasibly completed by elderly, frail patients and result in similar or even greater reductions in length of stay than for younger, healthier patients …”

Section: Discussionmentioning

confidence: 99%

The impact of frailty on perioperative outcomes and resource utilization in sinonasal cancer surgery

et al. 2019

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Objectives/Hypothesis Frailty is a measure of decreased physiologic reserve that has been associated with adverse outcomes in older surgical patients. We aimed to measure the association of preoperative frailty with outcomes in patients undergoing sinonasal cancer surgery. Study Design Retrospective cohort study. Methods We identified 5,346 patients in the Nationwide Readmissions Database undergoing sinonasal cancer surgery from 2010 to 2014. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty‐defining diagnoses indicator. Multivariate regression was used to analyze the association of frailty with postoperative outcomes. Results Frailty was present in 7.4% of patients. Frailty was a significant independent predictor of intensive care unit–level complications (odds ratio [OR]: 4.83; 95% confidence interval [CI]: 2.95‐7.93; P < .001) and nonhome discharge (OR: 3.07; 95% CI: 1.68‐5.60; P < .001). Compared to nonfrail patients, frail patients had threefold longer median length of stay (12 days vs. 4 days; P < .001) and more than twofold higher median hospital costs ($44,408 vs. $18,660; P < .001). Frailty outperformed advanced comorbidity (defined as Charlson‐Deyo score ≥3), age ≥80 years, and markers of surgical complexity (e.g., skull base/orbit involvement, flap reconstruction, neck dissection) in predicting serious complications, nonhome discharge, length of stay, and hospital costs. Conclusions Frailty appears to have a stronger and more consistent association with adverse outcomes and increased resource utilization after sinonasal cancer surgery than age or comorbidity index. This information may be used in surgical risk stratification and can guide strategies to prevent or mitigate adverse events in this high‐risk group. Level of Evidence NA Laryngoscope, 130:290–296, 2020

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“… 6 – 9 Other studies report smaller differences or no differences at all. 10 – 12 A similar controversy exists regarding the long-term postoperative survival of elderly after surgical treatment for CRC. Some studies show a decreased survival in elderly patients with CRC compared with younger patients.…”

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confidence: 99%

Long-Term Survival in Octogenarians After Surgical Treatment for Colorectal Cancer: Prevention of Postoperative Complications is Key

et al. 2018

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BackgroundWhether to treat octogenarians with colorectal cancer (CRC) in the same manner as younger patients remains a challenging issue. The purpose of this study was to analyse postoperative complications and long-term survival in a consecutive cohort of octogenarians who were surgically treated for CRC.MethodsOctogenarians with primary CRC suitable for curative surgery between January 2008 and December 2011 were included. Data about comorbidities, tumour stage, and complications were retrospectively collected from patient files. Data about survival were retrieved with use of the Dutch database for persons and addresses. To identify factors associated with severe postoperative complications and postoperative survival, logistic regression analyses, and Cox regression analyses were performed. Odds ratios and hazard ratios (HR) with 95% confidence intervals (CI) were estimated.ResultsIn a series of 108 octogenarians, median age was 83 years (range 80–94 years). Median follow-up was 47 (range 1–107) months. Major postoperative complications occurred in 25% of the patients. No risk factors for development of severe postoperative complications could be identified. The 30-day mortality was 7%; 1- and 5-year mortality was 19% and 56%, respectively. Overall median survival was 48 months: 66 months in patients without complications versus 13 months in patients with postoperative complications. Postoperative complications were most predictive of decreased survival (HR 3.16; 95% CI 1.79–5.59), even including tumour characteristics, comorbidity, and emergency surgery.ConclusionsLong-term survival in octogenarians deemed fit for surgery is reasonably good. Prevention of major postoperative complications could further improve clinical outcome.

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E.R.A.S. pathway in colorectal surgery in elderly: Our experience: A retrospective cohort study

Cited by 26 publications

References 22 publications

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

The impact of frailty on perioperative outcomes and resource utilization in sinonasal cancer surgery

Long-Term Survival in Octogenarians After Surgical Treatment for Colorectal Cancer: Prevention of Postoperative Complications is Key

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